Variations in plasma levels of adenosine 3',5'-monophosphate during clinical sepsis

Plasma levels of adenosine 3',5'-monophosphate were measured in 43 patients with bacterial infections of varying degrees of severity. The most severely ill patients, who died within 48 hours of study, had the highest levels of plasma adenosine 3',5'-monophosphate, 38.4+/-29.8 picomoles per milliliter. A significant and progressive decrease in plasma adenosine 3',5'-monophosphate level toward normal was found with lesser degrees of sepsis. However, even those patients who survived exhibited elevations of plasma adenosine 3',5'-monophosphate levels, 12.9+/-5.4 picomoles per milliliter, significantly above normal. Shock and impaired renal function appeared to contribute to the elevated levels found in the most severely ill patients. In those less severely ill, with normal renal function and no shock, the plasma adenosine 3',5'-monophosphate level was still significantly elevated above normal, suggesting that severe bacterial infection itself contributes to the generation of elevated plasma adenosine 3',5'-monophosphate levels. Various hormonal changes or increased cellular permeability, or both, may account for some of the increase of this intracellular nucleotide in the plasma. It is suggested that extremely high levels of plasma adenosine 3',5'-monophosphate are indicative of a poor prognosis.