Objective: To explore the regularity of changes in total adiponectin (APN) and high molecular bodyweight adiponectin (HAP) in sepsis, and its correlation with infection and its role on predicting prognosis.
Methods: A prospective study was conducted. Eighty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medicine University from June to November in 2011 were enrolled in this study. The plasma APN (both total APN and HAP), procalcitonin (PCT), and endotoxin were determined with enzyme linked immunosorbent assay (ELISA) at 2 hours, 2 days, and 6 days after ICU admission. The acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), and simplified acute physiology score II (SAPS II) scores were recorded, and insulin resistance index was calculated. Twenty healthy volunteers and 21 patients with systemic inflammation response syndrome (SIRS) were enrolled as controls and SIRS group.
Results: Plasma total APN and HAP in sepsis patients at 2 hours after ICU admission were significantly decreased compared with control group and SIRS group [total APN: 2.87 (2.28, 3.89) mg/L vs. 6.48±1.53 mg/L, 3.72 (2.67, 4.59) mg/L; HAP: 2.64 (2.07, 3.75) mg/L vs. 5.12±1.98 mg/L, 3.33 (2.23, 4.24) mg/L, P<0.05 or P<0.01]. A negative correlation was found between total APN and HAP in plasma and PCT (total APN r=-0.559, HAP r=-0.530, both P<0.01), but no correlation with endotoxin. Those correlations remained significantly in partial correlation analysis controlled by insulin resistance status. There were significances in APN among sepsis, severe sepsis and septic shock groups, and negative correlations were found between APN and APACHE II, SOFA, and SAPS II scores (total APN r value, -0.868, -0.766, -0.725; HAP r value, -0.859, -0.715, -0.692, all P<0.01). Total APN and HAP in plasma of survivors with sepsis (n=41) was gradually increased following the recovery of the disease (total APN χ(2)=34.520, HAP χ(2)=27.802, both P<0.01) and the level in non-survivors (n=7) was decreased (total APN χ(2)=3.938, HAP χ(2)=3.938, both P>0.05). The significantly negative correlations were found between total APN and HAP at 2 hours after ICU admission and ICU duration (total APN r=-0.275, P=0.014; HAP r=-0.299, P=0.007) and ventilation time (total APN r=-0.393, HAP r=-0.519, both P<0.01).
Conclusions: Plasma total APN and HAP was decreased in septic patients, and negatively correlated with PCT. Plasma total APN and HAP played a role in diagnosis of infection and predicting the outcomes, and correlated with severity of sepsis.