Kinetics of circulating fetuin A may predict mortality independently from adiponectin, high molecular weight adiponectin and prognostic factors in critically ill patients with sepsis: A prospective study
Purpose: Fetuin A and adiponectin, major hepatokine and adipokine respectively, have been implicated in systematic inflammation. Our aim was to jointly investigate whether kinetics of circulating fetuin A, adiponectin and its isoform HMWA predict 28 day mortality in sepsis. Materials and methods: In a prospective study, serum fetuin A, adiponectin and HMWA were determined in 102 ICU patients fulfilling the diagnostic criteria of SEPSIS 3, at enrollment and one week after, and in 102 healthy controls matched on age and gender. Results: Serum fetuin A was significantly lower in septic patients than controls (p 0.001) Among septic patients, those with septic shock and nonsurvivors presented lower fetuin A, but higher adiponectin and HMWA compared to patients with sepsis and survivors respectively, both at baseline and day 7 (p 0.001) Fetuin A exhibited negative correlations with APACHE II, CRP, procalcitonin, adiponectin and IL 6 but a positive one with albumin. Reduced fetuin A as well as lower serum kinetics of fetuin A (HR: 0.55, 95% C.I. 0.34 0.91, p 0.02) adiponectin but not HMWA were independently associated with 28 day mortality adjusting for age, gender, BMI, APACHE II, septic shock and laboratory biomarkers. Conclusions: Circulating fetuin A kinetics may be a prognostic biomarker in septic patients. More research is essential to elucidate fetuin A's ontological role in sepsis pathophysiology. HIGHLIGHTSSeptic patients have lower fetuin A but higher adiponectin and HMWA than controls.Serum fetuin A is reduced in septic shock compared to sepsis.Nonsurvivors present lower fetuin A kinetics during the first week of sepsis.Nonsurvivors show lower adiponectin and HMWA kinetics in the 1st week of sepsis.Circulating fetuin A kinetics is an independent predictor of mortality in sepsis.
Journal of critical care