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Article Dans Une Revue Critical Care Année : 2021

Monitoring circulating dipeptidyl peptidase 3 (DPP3) predicts improvement of organ failure and survival in sepsis: a prospective observational multinational study

Karine Santos
  • Fonction : Auteur
Dirk van Lier
  • Fonction : Auteur
Xavier Wittebole
  • Fonction : Auteur
Etienne Gayat
  • Fonction : Auteur
Oliver Hartmann
  • Fonction : Auteur
Joachim Struck
  • Fonction : Auteur
Andreas Bergmann
  • Fonction : Auteur
Massimo Antonelli
  • Fonction : Auteur
Albertus Beishuizen
  • Fonction : Auteur
Salvatore Di Somma
  • Fonction : Auteur
Thierry Dugernier
  • Fonction : Auteur
Vincent Huberlant
  • Fonction : Auteur
Gernot Marx
  • Fonction : Auteur
Peter Pickkers
  • Fonction : Auteur
Matthieu Legrand
  • Fonction : Auteur
Pierre-François Laterre
  • Fonction : Auteur

Résumé

Abstract Background Dipeptidyl peptidase 3 (DPP3) is a cytosolic enzyme involved in the degradation of various cardiovascular and endorphin mediators. High levels of circulating DPP3 (cDPP3) indicate a high risk of organ dysfunction and mortality in cardiogenic shock patients. Methods The aim was to assess relationships between cDPP3 during the initial intensive care unit (ICU) stay and short-term outcome in the AdrenOSS-1, a prospective observational multinational study in twenty-four ICU centers in five countries. AdrenOSS-1 included 585 patients admitted to the ICU with severe sepsis or septic shock. The primary outcome was 28-day mortality. Secondary outcomes included organ failure as defined by the Sequential Organ Failure Assessment (SOFA) score, organ support with focus on vasopressor/inotropic use and need for renal replacement therapy. cDPP3 levels were measured upon admission and 24 h later. Results Median [IQR] cDPP3 concentration upon admission was 26.5 [16.2–40.4] ng/mL. Initial SOFA score was 7 [5–10], and 28-day mortality was 22%. We found marked associations between cDPP3 upon ICU admission and 28-day mortality (unadjusted standardized HR 1.8 [CI 1.6–2.1]; adjusted HR 1.5 [CI 1.3–1.8]) and between cDPP3 levels and change in renal and liver SOFA score ( p = 0.0077 and 0.0009, respectively). The higher the initial cDPP3 was, the greater the need for organ support and vasopressors upon admission; the longer the need for vasopressor(s), mechanical ventilation or RRT and the higher the need for fluid load (all p < 0.005). In patients with cDPP3 > 40.4 ng/mL upon admission, a decrease in cDPP3 below 40.4 ng/mL after 24 h was associated with an improvement of organ function at 48 h and better 28-day outcome. By contrast, persistently elevated cDPP3 at 24 h was associated with worsening organ function and high 28-day mortality. Conclusions Admission levels and rapid changes in cDPP3 predict outcome during sepsis. Trial Registration ClinicalTrials.gov, NCT02393781. Registered on March 19, 2015.
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Dates et versions

hal-04182329 , version 1 (10-04-2024)

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Alice Blet, Benjamin Deniau, Karine Santos, Dirk van Lier, Feriel Azibani, et al.. Monitoring circulating dipeptidyl peptidase 3 (DPP3) predicts improvement of organ failure and survival in sepsis: a prospective observational multinational study. Critical Care, 2021, 25 (1), pp.61. ⟨10.1186/s13054-021-03471-2⟩. ⟨hal-04182329⟩
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