Dmitted to a mixed medical/surgical ICU and compared these with the ICU outcome. Patients who

Dmitted to a mixed medical/surgical ICU and compared these with the ICU outcome. Patients who met systemic inflammatory response syndrome (SIRS) criteria [2] and had lactate 4 mmol/l or systolic blood pressure 90 mmHg met the Rivers criteria. Results We included 98 patients admitted to the ICU (60 males) of mean age 61 ?17 years. Fourteen patients (14 ) died in the ICU, and the median length of stay was 3 (IQR 3) days. Overall 16 of the 98 patients met the Rivers criteria, four of whom died (25 ). The median PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/20801500 length of ICU stay for the Rivers patients was 5 (1.25) days (see Table 1). Conclusions (1R,2S)-VU0155041 web Sixteen out of 98 patients (16 ) met Rivers criteria. Of medical and surgical emergency patients, this proportion rose to 16 of 55 patients (29 ). We hypothesized that plasma DNA is increased in septic patients admitted to the ICU compared with nonseptic ICU patients, and it is correlated with disease severity and clinical outcome. Forty-two consecutive patients (11 septic, 31 nonseptic) admitted to a mixed ICU and mechanically ventilated were recruited. Plasmafree DNA concentration was measured by real-time PCR assay for the -globin gene, and the APACHE II score, SOFA score, serum C-reactive protein (CRP) concentrations, procalcitonin (PCT) concentrations, serum lipid concentrations, and clinical outcome (ICU/hospital days and mortality) were assessed on admission to the ICU. Assessments and samplings were repeated as the diagnosis of the patients changed (sepsis, severe sepsis and septic shock). Finally, 86 plasma samples were collected. Descriptive statistics, Mann hitney U, Kruskall allis and Spearman’s tests, and receiver operating characteristic analysis were used when appropriate. Demographic data were similar. ICU and hospital mortalities were 26.2 and 33.3 , respectively. The mean DNA concentrations on admission were significantly higher in ICU patients compared with healthy subjects (n = 11) (13,405 GE/ml versus 390 GE/ml, P < 0.05) and septic patients compared with nonseptic patients (33,170 GE/ml versus 1,171 GE/ml, P < 0.001). Furthermore, during the overall ICU stay, increased DNA concentration associated with the increase of severity of illness was noted; however, this increase was statistically significant only between septic and septic shock samples (26,624 GE/ml versus 42,861 GE/ml, P < 0.05). The area under the curve obtained for the plasma-free DNA concentration in distinguishing between septic and nonseptic patients on admission was 0.9 (sensitivity 84 , specificity, 95 ; cutoff 4,083 GE/ml). Also, the plasma-free DNA concentration was found to be higher in patients who died in the ICU compared with patients who survived, although not statistically significant. The DNA concentration demonstrated a significant correlation with CRP (P = 0.037, r = 0.365), PCT (P = 0.007, r = 0.457) and highdensity lipoprotein (P = 0.015, r = ?.415) concentrations. In conclusion, plasma DNA may be a potentially valuable tool to confirm the diagnosis of sepsis on admission to the ICU and to monitor disease severity. Reference 1. Rhodes A, et al.: Plasma DNA concentration as a predictor of mortality and sepsis in critically ill patients. Crit Care 2006, 10:142.Conclusion Inflammation is a potent cause of oxidative stress, which in turn results in endothelial damage and increased concentrations of unmeasured anions. The combination of CRP and the CIG, as markers of inflammation and inadequate tissue perfusion, respectively, is a powerful predictor.