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1. Acid sphingomyelinase serum activity predicts mortality in intensive care unit patients after systemic inflammation: a prospective cohort study.

Author

Matthias Kott, Gunnar Elke, Maike Reinicke, Supandi Winoto-Morbach, Dirk Schädler, Günther Zick, Inéz Frerichs, Norbert Weiler, and Stefan Schütze

Subjects
Medicine, Science
Abstract

Acid sphingomyelinase is involved in lipid signalling pathways and regulation of apoptosis by the generation of ceramide and plays an important role during the host response to infectious stimuli. It thus has the potential to be used as a novel diagnostic marker in the management of critically ill patients. The objective of our study was to evaluate acid sphingomyelinase serum activity (ASM) as a diagnostic and prognostic marker in a mixed intensive care unit population before, during, and after systemic inflammation.40 patients admitted to the intensive care unit at risk for developing systemic inflammation (defined as systemic inflammatory response syndrome plus a significant procalcitonin [PCT] increase) were included. ASM was analysed on ICU admission, before (PCT before), during (PCT peak) and after (PCT low) onset of SIRS. Patients undergoing elective surgery served as control (N = 8). Receiver-operating characteristics curves were computed.ASM significantly increased after surgery in the eight control patients. Patients from the intensive care unit had significantly higher ASM on admission than control patients after surgery. 19 out of 40 patients admitted to the intensive care unit developed systemic inflammation and 21 did not, with no differences in ASM between these two groups on admission. In patients with SIRS and PCT peak, ASM between admission and PCT before was not different, but further increased at PCT peak in non-survivors and was significantly higher at PCT low compared to survivors. Survivors exhibited decreased ASM at PCT peak and PCT low. Receiver operating curve analysis on discrimination of ICU mortality showed an area under the curve of 0.79 for ASM at PCT low.In summary, ASM was generally higher in patients admitted to the intensive care unit compared to patients undergoing uncomplicated surgery. ASM did not indicate onset of systemic inflammation. In contrast to PCT however, it remained high in non-surviving ICU patients after systemic inflammation.

Published
2014
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2. Acid sphingomyelinase serum activity predicts mortality in intensive care unit patients after systemic inflammation: a prospective cohort study

Author

Gunnar Elke, Inéz Frerichs, Norbert Weiler, Matthias Kott, Supandi Winoto-Morbach, Maike Reinicke, Stefan Schütze, Günther Zick, and Dirk Schädler

Subjects
Male, Critical Care and Emergency Medicine, lcsh:Medicine, Pilot Projects, Pathology and Laboratory Medicine, Systemic inflammation, Biochemistry, Procalcitonin, law.invention, Cohort Studies, law, Medicine and Health Sciences, Prospective Studies, Prospective cohort study, lcsh:Science, Immune Response, education.field_of_study, Multidisciplinary, Area under the curve, respiratory system, Prognosis, Lipids, Intensive care unit, Systemic Inflammatory Response Syndrome, Intensive Care Units, C-Reactive Protein, Sphingomyelin Phosphodiesterase, Lactates, Female, medicine.symptom, hormones, hormone substitutes, and hormone antagonists, Research Article, Calcitonin, Risk, medicine.medical_specialty, Calcitonin Gene-Related Peptide, Immunology, Population, Lipid Mediators, Signs and Symptoms, Sepsis, Internal medicine, parasitic diseases, medicine, Humans, Protein Precursors, Elective surgery, Intensive care medicine, education, Aged, Inflammation, Sphingolipids, business.industry, lcsh:R, Biology and Life Sciences, medicine.disease, bacterial infections and mycoses, Systemic inflammatory response syndrome, ROC Curve, lcsh:Q, business, Biomarkers
Abstract

INTRODUCTION Acid sphingomyelinase is involved in lipid signalling pathways and regulation of apoptosis by the generation of ceramide and plays an important role during the host response to infectious stimuli. It thus has the potential to be used as a novel diagnostic marker in the management of critically ill patients. The objective of our study was to evaluate acid sphingomyelinase serum activity (ASM) as a diagnostic and prognostic marker in a mixed intensive care unit population before, during, and after systemic inflammation. METHODS 40 patients admitted to the intensive care unit at risk for developing systemic inflammation (defined as systemic inflammatory response syndrome plus a significant procalcitonin [PCT] increase) were included. ASM was analysed on ICU admission, before (PCT before), during (PCT peak) and after (PCT low) onset of SIRS. Patients undergoing elective surgery served as control (N = 8). Receiver-operating characteristics curves were computed. RESULTS ASM significantly increased after surgery in the eight control patients. Patients from the intensive care unit had significantly higher ASM on admission than control patients after surgery. 19 out of 40 patients admitted to the intensive care unit developed systemic inflammation and 21 did not, with no differences in ASM between these two groups on admission. In patients with SIRS and PCT peak, ASM between admission and PCT before was not different, but further increased at PCT peak in non-survivors and was significantly higher at PCT low compared to survivors. Survivors exhibited decreased ASM at PCT peak and PCT low. Receiver operating curve analysis on discrimination of ICU mortality showed an area under the curve of 0.79 for ASM at PCT low. CONCLUSIONS In summary, ASM was generally higher in patients admitted to the intensive care unit compared to patients undergoing uncomplicated surgery. ASM did not indicate onset of systemic inflammation. In contrast to PCT however, it remained high in non-surviving ICU patients after systemic inflammation.

Published
2014

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