Serum nitric oxide and pediatric sepsis outcomes

Abstract

Background Sepsis is the complex pathophysiologic responses of the host against systemic infection. Sepsis can cause severe conditions such as septic shock and multiple organ failure. Although we have a better understanding of the molecular basis of sepsis as well as aggressive therapy, the mortality rate remains high, between 20-80%. Nitric oxide (NO) is one of the mediators associated with cardiovascular failure, apoptosis and organ dysfunction in sepsis. Objective To evaluate for a possible correlation between NO levels and outcomes in pediatric sepsis. Methods A prospective cohort study was conducted at the pediatric intensive care unit (PICU) of Prof. Dr. R.D. Kandou General Hospital in Manado, from June to November 2012. Forty children aged one month to five year old, fulfilled the International Pediatrics Sepsis Consensus Conference 2 005 criteria were recruited. Nitrite oxide metabolites (nitrite and nitrate) levels were measured using a calorimetric assay kit (Cayman®, Catalog No.780001) from venous blood specimens collected at admission. All patients received antibiotics empirically within an hour of the diagnosis. Outcomes of patients recorded were survivor or died, and length of stay in PICU. Results Mann-Whitney U test revealed a significant difference between median serum NO levels ins urvivors and those who died (18.60 vs. 36.50 fLM/L, respectively; P= 0.016). Conclusion Serum NO concentration is higher in those who died than in survivors of pediatric sepsis. Specific NO inhibition may be beneficial in decreasing morbidity and mortality in this condition.

Keywords

• nitric oxide, sepsis, mortality, pediatric