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Elevated VIP and endotoxin plasma levels in human gram-negative septic shock
P Brandtzaeg1, O Oktedalen, P Kierulf
1Department of Infectious Diseases, Ullevål University Hospital, Oslo, Norway.
Abstract:
Vasoactive intestinal polypeptide (VIP) and endotoxin (lipopolysaccharides, LPS) were measured in plasma samples from 11 patients with bacteriologically verified meningococcal disease. Five patients suffered fulminant septicaemia, developed severe septic shock, and 2 died due to circulatory collapse. Initially, all 5 had levels of VIP above 4 pM and plasma endotoxin above 200 ng/liter. Five patients were diagnosed as meningitis and 1 as having meningococcaemia, all with a normal circulatory state. None of these 6 patients had initially levels of VIP above 2.5 pM or endotoxin levels above 25 ng/liter (P less than 0.001). A correlation existed between plasma endotoxin and VIP levels (r = 0.735, P = 0.01). Sequentially collected samples from 3 patients showed rapidly declining VIP levels after initiation of antibiotic and fluid treatment. These results are in agreement with previous animal experiments, suggesting that endotoxin directly or indirectly stimulates the VIP-ergic nervous system in the initial phase of gram-negative septic shock in man.
Insights
In meningococcal disease, high levels of vasoactive intestinal polypeptide (VIP) and endotoxin (lipopolysaccharides, LPS) indicate severe septic shock. Treatment rapidly reduced VIP levels, suggesting endotoxin stimulates the VIP-ergic system.
Area of Science:
- Microbiology
- Neuroendocrinology
- Critical Care Medicine
Background:
- Meningococcal disease can lead to severe septic shock.
- Endotoxins (lipopolysaccharides, LPS) are key components of Gram-negative bacteria implicated in sepsis.
- Vasoactive intestinal polypeptide (VIP) is a neuropeptide with known roles in physiological regulation.
Purpose of the Study:
- To investigate the relationship between plasma levels of vasoactive intestinal polypeptide (VIP) and endotoxin (lipopolysaccharides, LPS) in patients with meningococcal disease.
- To determine if these markers correlate with disease severity and circulatory status.
- To observe the effect of treatment on VIP levels.
Main Methods:
- Plasma samples were collected from 11 patients with bacteriologically verified meningococcal disease.
- Vasoactive intestinal polypeptide (VIP) and endotoxin (lipopolysaccharides, LPS) levels were measured.
- Patients were categorized based on clinical presentation (fulminant septicaemia with septic shock vs. meningitis/meningococcaemia).
- Sequential samples were analyzed from 3 patients during treatment.
Main Results:
- Patients with severe septic shock (n=5) had significantly higher initial levels of VIP (>4 pM) and endotoxin (>200 ng/liter) compared to those with meningitis/meningococcaemia (n=6) (VIP ≤2.5 pM, endotoxin ≤25 ng/liter; P < 0.001).
- A strong positive correlation was found between plasma endotoxin and VIP levels (r = 0.735, P = 0.01).
- VIP levels decreased rapidly in 3 patients following antibiotic and fluid treatment.
Conclusions:
- Elevated plasma endotoxin and VIP levels are associated with severe septic shock in meningococcal disease.
- Endotoxin appears to stimulate the VIP-ergic nervous system during the initial phase of Gram-negative septic shock.
- VIP levels may serve as a biomarker for disease severity and response to treatment in meningococcal sepsis.