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Prognostic value of malondialdehyde serum levels in severe sepsis: a multicenter study
Leonardo Lorente1, María M Martín, Pedro Abreu-González
1Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com
Objective:
The oxidant/antioxidant state in septic patients has only been studied in small series. We wished to determine whether malondialdehyde (MDA) serum levels were associated with severity and 30-day mortality in a large series of patients with sepsis.
Methods:
We performed an observational, prospective, multicenter study in six Spanish Intensive Care Units. Serum levels of MDA were measured in a total of 228 patients (145 survivors and 83 non-survivors) with severe sepsis and 100 healthy controls.
Results:
Serum levels of MDA were higher in severe septic patients than in healthy controls. Non-surviving septic patients had higher MDA values than survivors. MDA serum levels were associated with severity markers (lactic acid, SOFA, APACHE-II) and coagulation indices. Regression analysis showed that MDA serum levels were associated with 30-day survival (Hazard ratio = 1.05; 95% confidence interval = 1.009-1.091; p = 0.016). Receiver operating characteristic analysis showed that the area under curve of MDA serum levels to predict 30-day survival was 0.62 (95% CI = 0.56-0.69; P = 0.002). The risk of death in septic patients with MDA serum levels above 4.11 nmol/mL was higher than in patients with lower values (Hazard Ratio = 2.43; 95% CI = 1.49-3.94; p<0.001).
Conclusions:
The novel findings of our study on severe septic patients, to our knowledge the largest series providing data on the oxidative state, are that elevated MDA serum levels probably represent an unbalanced oxidant state and are related with poor prognosis in patients with severe sepsis.
Insights
Elevated malondialdehyde (MDA) serum levels in severe sepsis patients indicate an unbalanced oxidant state. Higher MDA levels are linked to increased severity and a greater risk of 30-day mortality in sepsis.
Area of Science:
- Biochemistry
- Critical Care Medicine
- Oxidative Stress Research
Background:
- The oxidant/antioxidant balance in sepsis is not well-characterized in large patient cohorts.
- Previous studies on oxidative stress markers in sepsis were limited in scope.
Purpose of the Study:
- To investigate the association between serum malondialdehyde (MDA) levels and sepsis severity.
- To determine if MDA serum levels predict 30-day mortality in a large cohort of severe sepsis patients.
Main Methods:
- An observational, prospective, multicenter study was conducted in six Spanish ICUs.
- Serum MDA levels were measured in 228 severe sepsis patients (145 survivors, 83 non-survivors) and 100 healthy controls.
- Statistical analyses included regression and ROC analysis to assess MDA's predictive value.
Main Results:
- Severe septic patients exhibited higher serum MDA levels compared to healthy controls.
- Non-survivors had significantly higher MDA levels than survivors.
- MDA levels correlated with established severity markers (lactate, SOFA, APACHE-II) and coagulation indices.
- Elevated MDA was independently associated with increased 30-day mortality (HR 1.05) and predicted survival (AUC 0.62).
Conclusions:
- Elevated serum MDA levels in severe sepsis likely signify an imbalanced oxidant state.
- MDA serum levels serve as a valuable prognostic marker, correlating with severity and predicting mortality in severe sepsis.
- This study represents the largest series to date examining the oxidative state in severe sepsis.