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Endogenous glycosides in critically ill patients.
Elmar Berendes1, Paul Cullen, H Van Aken
1Klinik und Poliklinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Münster, Germany.
Critical Care Medicine
|May 29, 2003
Summary
Critically ill patients often have elevated endogenous digitalis-like substances (DLIS) and ouabain, linked to higher mortality. These substances correlate with illness severity and inflammation, impacting cardiac function and survival.
Area of Science:
- Endocrinology
- Critical Care Medicine
- Cardiology
Background:
- Endogenous digitalis-like-immunoreactive substances (DLIS) and ouabain are implicated in cardiovascular regulation.
- Their role in critically ill patients, particularly concerning inflammation and outcomes, requires further elucidation.
Purpose of the Study:
- To determine the incidence of DLIS and endogenous ouabain in critically ill patients.
- To investigate the association of these substances with laboratory variables, disease severity, cardiac function, inflammation, and mortality.
Main Methods:
- Sera from 401 critically ill patients (not on cardiac glycosides) were analyzed for DLIS (digoxin, digitoxin) and endogenous ouabain.
- Inflammatory mediators, severity scores (APACHE II, Goris), and hemodynamic parameters (in a subgroup) were measured.
Main Results:
- 14.5% of patients were DLIS-positive; mean endogenous ouabain was elevated in both DLIS-positive and DLIS-negative patients compared to controls.
- DLIS and ouabain correlated with illness severity scores and inflammatory markers.
- DLIS-positive patients had higher mortality (12% vs. 3.2%) and impaired left ventricular function.
Conclusions:
- Elevated endogenous glycosides, including ouabain, are common in critically ill patients.
- Their presence is linked to increased morbidity and mortality, potentially mediated by systemic inflammation.
- DLIS, but not ouabain, showed a relationship with left ventricular function.