The role of resistin and myeloperoxidase in severe sepsis and septic shock: results from the ALBIOS trial

Background: Inflammatory biomarkers are useful in detecting patients with sepsis. The prognostic role of resistin and myeloperoxidase (MPO) has been investigated in sepsis. Materials and methods: Plasma resistin and MPO were measured on days 1, 2, and 7 in 957 patients enrolled in the Albumin Italian Outcome Sepsis (ALBIOS) trial. The association between resistin and MPO levels on day 1, 2, and 7 and 90-day mortality was assessed. Results: Plasma resistin and MPO concentrations were higher at day 1 and decreased until day 7. Both biomarkers were positively correlated to each other and with physiological parameters. Higher levels of resistin and MPO on day 1 were associated with the development of new organ failures. Patients experiencing death at 90 days showed higher levels of resistin or MPO compared to survivors. At day 1, only MPO in the 4th quartile (Q4), but not resistin, was found to predict 90-day death (adjusted hazard ratio [aHR] 1.55 vs. Q1). At day 2, resistin in the 3rd and 4th quartiles predicted a >40% increase in mortality as also did MPO in the 4th quartile. On day 7, Q4 resistin was able to predict 90-day mortality, while all quartiles of MPO were not. Conclusions: High levels of MPO, but not of resistin, on day 1 were able to predict 90-day mortality. These findings may either suggest that early hyper-activation of neutrophils is detrimental in patients with sepsis or reflect the burden of the inflammatory process caused by sepsis (ALBIOS ClinicalTrials.gov Identifier: NCT00707122).