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Aims and Objectives: Sepsis is an acute life-threatening systemic inflammatory response to infection. C-reactive protein (CRP) and albumin are positive and negative acute phase proteins respectively, following opposing patterns in sepsis. We aim to investigate whether CRP/albumin ratio is a better prognostic marker of 28-day mortality in critically ill patients with sepsis than CRP alone. Methods: In a prospective study, CRP and albumin were determined in serum of 102 critically ill patients (57 males, age 65±15 years, APACHE II 23±7, SOFA 10±3) at sepsis onset and one week after. Results: Thirty patients (29.4%) died within 28 days from enrolment. CRP and CRP/albumin ratio decreased significantly one week after sepsis onset (145±94 vs 91±71mg/L, p Conclusions: CRP/albumin ratio is a good predictor of 28-day mortality in critically ill patients with sepsis, similar to CRP but better than SOFA and APACHE II scores.

Aims and Objectives: Sepsis constitutes an acute inflammatory response to infection affecting liver function. Increased serum bilirubin as well as decreased fetuin-A, a major hepatokine, have been shown in critically ill patients with sepsis. We aim to explore the association of serum bilirubin/fetuin-A (B/F) ratio early in sepsis with severity and outcome. Methods: In a prospective study, serum total bilirubin and fetuin-A were determined in 90 critically ill patients (52 males, age 65±15 years, APACHE II 24 ±7, SOFA 10±3) at sepsis onset and one week after. B/F ratio was calculated using the formula 10.000 x Bilirubin (mg/dL) / Fetuin-A (μg/mL). Mortality rate at 28 days after enrollment was the primary outcome. Results: Twenty eight patients (31%) died within 28 days. Bilirubin and fetuin-A increased one week after sepsis onset compared to baseline (1.16±2.3 vs 1.38±2.84mg/dL, p=0.03 and 306±107 vs 372±147μg/mL, p Conclusions: B/F ratio at sepsis onset is associated with severity and outcome and may be a useful prognostic biomarker in critically ill septic patients.

Aims and Objectives: Sepsis results in severe lipid metabolic alterations. Lipids exert important immunomodulatory actions during infection. We aim to investigate whether serum lipid changes early in sepsis are associated with severity and outcome. Methods: In a prospective study, serum total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides (TG) were determined in 82 critically ill patients (49 males, age 65±14 years, APACHE II 23±7, SOFA 10±3) at sepsis onset and one week after, and in 82 age and gender-matched healthy controls. Results: Upon enrollment, TC, HDL and LDL were significantly lower and TG were higher in patients compared to controls (p Conclusions: Critically ill septic patients exhibit significant alterations of serum lipids associated with sepsis severity and outcome.

Introduction: Non small cell lung cancer (NSCLC) is the leading cause of cancer-related death globally. There is a tremendous interest in identifying novel biomarkers. The pathophysiological role of classic and novel adipokines in NSCLC is not yet fully understood and their value as diagnostic biomarkers is currently under research. Aim: To explore the diagnostic potential of classic (leptin, adiponectin) and novel adipokines (chemerin, plasminogen activator inhibitor-1 activity/PAI-1) in resectable NSCLC. Methods: In a large case-control study, circulating chemerin, adiponectin, leptin and PAI-1 were determined in 110 consecutive patients with resectable NSCLC and 110 healthy controls matched on age (± 5 years), gender and date of blood draw (± 1 month). Serum leptin, chemerin and adiponectin were determined by ELISA (BioVendor and ALPCO). Plasma PAI-1 activity was determined using Berichrom® PAI (Siemens). Results: Patients with NSCLC had significantly higher chemerin and PAI-1 activity (p Conclusion: Novel adipokines showed higher discriminative ability than classic adipokines in the NSCLC diagnosis. More prospective studies are required to assess the potential diagnostic significance of novel adipokines in NSCLC.

Introduction: Non-traumatic coma (NTC) is a common cause of critical illness with diverse etiology and prognosis Aim: To investigate the etiology and outcome of NTC in ICU patients and to explore prognostic factors Methods: In a retrospective study we reviewed the medical records of all patients admitted to the ICU of a teaching hospital due to NTC, from January 2018 to January 2019. Demographic data, medical history, APACHE II score, etiology of coma and ICU mortality were recorded. Results: Among 250 medical records, we identified 30 cases (16 males, mean age 68±14, APACHE II 21±7) of NTC. The etiology of NTC was: intracerebral hemorrhage (8), respiratory failure (6), sepsis (5), post-anoxic (4), CNS infection (3), ischemic stroke (2), metabolic coma (2). Thirteen patients died in the ICU (43%) and 17 were discharged. Sepsis presented the highest ICU mortality (80%), followed by post-anoxic (75%), intracerebral hemorrhage (62%) and ischemic stroke (50%). All patients with respiratory failure, CNS infection and metabolic coma survived to discharge. Sex, age, APACHE II score and history of chronic kidney, respiratory, cardiovascular disease or malignancy were not correlated with ICU mortality (p>0.05). Elevated serum lactate (p:0.018), acute kidney injury (p:0.005) and hypotension (p:0.033) at admission were associated with ICU mortality. Acute kidney injury on the day of admission tripled the risk of death (HR:2.8, 95%CI: 1.2-6.6, p Conclusion: Intracerebral hemorrhage was the leading cause of NTC, followed by respiratory failure and sepsis. Acute kidney injury was the best predictor of ICU mortality.

Background: Experimental and clinical data have shown that the adipocytokines eNAMPT and resistin interact with cytokines and other inflammatory molecules in the pathogenesis of sepsis. Objective: To investigate eNAMPT and resistin’s role as biomarkers of sepsis compared to well-established inflammatory markers and cytokines. Methods: We prospectively studied 102 critically ill patients (57 males, mean age 65±15years) fulfilling the diagnostic criteria of SEPSIS-3, during the first week of sepsis. Serum eNAMPT and resistin were determined by ELISA (Phoenix Pharmaceuticals, CA, USA) at sepsis onset and one week after. We also determined C-reactive protein (CRP), procalcitonin, interleukins IL-6, IL-10, tumor necrosis factor alpha (TNF-α) and soluble urokinase-type plasminogen activator receptor (suPAR). The discriminating power of measured parameters as predictors of sepsis and septic shock was obtained by Receiver Operating Characteristic (ROC) curves. Results: Sixty patients presented with sepsis and 42 with septic shock. Mortality within 28 days was 29.4%. eNAMPT exhibited significantly positive correlations with CRP, procalcitonin and IL-10 at admission, and with procalcitonin one week after enrollment. Resistin was positively correlated with IL-6, IL-10 and TNF-α at admission and with procalcitonin one week after enrollment. Area under ROC curves showed that eNAMPT (AUROC>0.83) and CRP (AUROC>0.78) outperformed procalcitonin (AUROC>0.71), resistin (AUROC>0.69), IL-6 (AUROC>0.69), IL-10 (AUROC>0.68) and suPAR (AUROC>0.64) in discriminating sepsis from septic shock. Conclusion: eNAMPT is a better discriminator biomarker for sepsis and septic shock, while resistin’s performance is comparable to procalcitonin.

Background: eNAMPT, an adipokine with pro-inflammatory properties, has been implicated in acute and chronic inflammation. However, its kinetics has not been studied in sepsis. Objective: To investigate whether eNAMPT and its kinetics early in sepsis predict severity and outcome. Methods: In a prospective case-control study, serum eNAMPT concentrations were determined by ELISA in 102 critically ill patients (57 males, mean age 65±15 years) fulfilling the diagnostic criteria of SEPSIS-3, at sepsis onset and one week after, and in 102 age and gender-matched healthy controls. Results: Sixty patients presented with sepsis and 42 with septic shock. Mean APACHE II was 23±7. Thirty patients died within 28 days (mortality 29.4%). At admission, serum eNAMPT was significantly higher in patients compared to controls (79.1±19.5 vs 44.9±27.5ng/mL, p Conclusion: eNAMPT in early sepsis may be a novel diagnostic and prognostic biomarker in critically ill septic patients.

Background: Adiponectin, the most abundant active adipokine, exhibits anti-inflammatory properties affecting survival in critical illness. Objective: To explore whether kinetics of serum adiponectin and its main isoform HMWA is associated with 28-day mortality in sepsis. Methods: In a prospective study, serum adiponectin and HMWA concentrations were determined by ELISA (ALPCO) in 102 ICU patients fulfilling the diagnostic criteria of SEPSIS-3, at enrollment and one week after, and in 102 healthy controls matched on age and gender. Results: At admission, serum adiponectin (and HMWA) was significantly elevated in septic patients than in healthy controls (10.33 ± 2.96 vs 6.25 ± 1.53 μg/mL, p Conclusion: Kinetics of serum adiponectin may be independently associated with mortality in septic patients.