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Interactions of endotoxin with cortisol and acute phase proteins in septic shock neonates
Insights
In septic shock neonates, endotoxemia elevates cortisol and immature neutrophil counts. This precedes the rise in acute-phase proteins, suggesting complex interactions during early infection.
Area of Science:
- Neonatal Medicine
- Immunology
- Endocrinology
Background:
- Sepsis is a leading cause of neonatal mortality.
- Understanding the early inflammatory markers in neonatal sepsis is crucial for timely intervention.
- Endotoxemia plays a significant role in the pathogenesis of sepsis.
Purpose of the Study:
- To investigate the relationship between endotoxemia, cortisol levels, immature neutrophil counts, and acute-phase proteins in neonatal septic shock.
- To explore the temporal sequence of these markers in the early stages of infection.
Main Methods:
- Studied 13 neonates with septic shock.
- Measured C-reactive protein (CRP), alpha 1-acid glycoprotein, and haptoglobin.
- Assessed endotoxin presence, serum cortisol concentrations, and immature neutrophil counts (band/neutrophil ratio).
Main Results:
- Eight out of 13 neonates had detectable endotoxin.
- Neonates with endotoxemia exhibited significantly higher serum cortisol levels (917 +/- 596 ng/ml) compared to those without (398 +/- 239 ng/ml).
- Elevated cortisol and increased immature neutrophil counts preceded the rise in CRP, alpha 1-acid glycoprotein, and haptoglobin in four extremely premature neonates.
Conclusions:
- Positive interactions exist between endotoxin, cortisol, and acute-phase protein synthesis during the initial phase of neonatal infection.
- Delayed acute-phase protein synthesis is suspected in extremely premature neonates, indicating a potential difference in immune response.
Abstract:
CRP, alpha 1-acid glycoprotein and haptoglobin were studied in 13 septic shock neonates. Endotoxin was recovered from eight infants. Serum cortisol concentration from infants with endotoxemia (917 +/- 596 ng/ml) was significantly higher than that from infants without endotoxemia (398 +/- 239 ng/ml). Serum cortisol correlated well with immature neutrophil counts defined as the unit "band/neutrophil". Increased cortisol level and immature neutrophil counts preceded the elevation of CRP, alpha 1-acid glycoprotein and haptoglobin in four extremely premature neonates. We conclude that positive interactions between endotoxin, cortisol and acute phase protein synthesis are present in the initial period of infection, and delayed acute phase protein synthesis is suspected in extremely premature neonates.