Key Points
- To evaluate the utility of plasma angiopoietin-1 and angiopoietin-2 levels as prognostic biomarkers of organ morbidity and 28-day mortality in patients with severe sepsis.
- Multicenter longitudinal cohort study of 70 patients with severe sepsis enrolled within 24 hours of criteria fulfillment across three tertiary hospital ICUs in Hamilton, Ontario, Canada.
- Plasma angiopoietin-1 and angiopoietin-2 were measured at ICU admission for all 70 patients, and serially (daily for 1 week, then weekly) for a subset of 43 patients until day 28, discharge, or death.
- Outcomes included 28-day mortality and morbidity assessed via the Multiple Organ Dysfunction score, analyzed using multivariable logistic regression and linear mixed models.
- Admission angiopoietin-1 levels ≤ 5.5 ng/mL significantly predicted 28-day mortality (RR 0.49, 95% CI 0.25–0.98, p = .046; adjusted OR 0.282, 95% CI 0.086–0.93, p = .037).
- Survivors had significantly higher daily angiopoietin-1 levels (peak median 13 vs. 10 ng/mL, p = .019) and lower daily angiopoietin-2 levels (nadir median 2.8 vs. 6.2 ng/mL, p = .013) compared with nonsurvivors.
- A biomarker panel combining angiopoietin-1, angiopoietin-2, and three endothelial activation markers accurately discriminated between fatal and nonfatal cases (c-index 0.80, 95% CI 0.69–0.90, p < .001).
Structured PICO
Do angiopoietin-1 and angiopoietin-2 levels predict 28-day mortality and morbidity in patients with severe sepsis?
PPopulation70 patients with severe sepsis enrolled within 24 hours of meeting inclusion criteria
IInterventionMeasurement of plasma angiopoietin-1 and angiopoietin-2 levels
OOutcome28-day mortality and morbidity measured by the Multiple Organ Dysfunction scorehard clinical
Angiopoietin-1 and angiopoietin-2 levels correlate with 28-day mortality and organ dysfunction in severe sepsis, suggesting their utility as prognostic biomarkers.