PURPOSE: Sepsis constitutes a significant public health problem and the mechanisms that regulate the inflammatory response are incompletely understood. Endogenous human peptides have been reported to modulate the response to bacterial infection in sepsis, independent of known mechanisms of antibiotic resistance. We sought to investigate the role of Cathelicidin Anti-Microbial Peptide (CAMP) and its expression in clinical sepsis.
METHODS: During two weeks in August 2007, 15 sepsis patients admitted consecutively to the intensive care unit were identified and confirmed by two physicians. Serum from 12 was obtained prior to treatment and ELISA was performed on each sample for CAMP. Cases were divided into high and low CAMP levels by median. Demographics, severity, acuity, length of stay (LOS), ICU length of stay, and in-hospital mortality were obtained.
RESULTS: CAMP levels were 1482 +/− 289 (S.D.) for the high group and 712 +/− 263 (S.D.) for low group. 24 hour APACHE scores were 19 +/− 7 and 23 +/− 14 for the groups for the high and low groups, respectively. Acuity scores (QTISS and CLASSACT) were comparable. Mean ages were 74 +/−16 and 64 +/− 15, respectively. The high group had lower percentages of African Americans (17% versus 33%) and ethnic hispanics (0% versus 33%). Average length of stay was 9 +/− 4 for the high group and 25 +/− 18 for the low group (p=.07), and ICU LOS was 3.6 +/− 1.6 and 10.4 +/− 7.3 respectively, for patients who survived (p=.05). 3/6 patients in the low group died or went to hospice and none in the high group. Ejection fractions, rates of diastolic dysfunction, estimated filling pressures, and organisms identified were similar.
CONCLUSION: In very preliminary analysis, low CAMP levels appear to be associated with poor outcomes in sepsis, despite similar severity, acuity, and organism types. Further investigation is warranted to look at factors implicated in outcomes and levels of CAMP.
CLINICAL IMPLICATIONS: Further work is warranted on endogenous mediators of responses to sepsis and biomarkers of poor outcome in sepsis.
DISCLOSURE: Dani Hackner, No Financial Disclosure Information; Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Cathelicidin assays are not approved for clinical applications at this time. This is basic research into the levels of bacterial killing proteins in clinical sepsis.