Time course of plasma gelsolin concentrations during severe sepsis in critically ill surgical patients.

Introduction: Gelsolin is an actin-binding plasma protein that is part of an 'actin-scavenging' system. Studies suggest that plasma gelsolin may play a crucial role in the pathophysiology of sepsis. Little is known about the course of plasma gelsolin levels over time in patients with severe sepsis. The aim of the study was to investigate plasma gelsolin levels in severe septic patients and to determine whether these levels predict the severity or clinical outcome of severe sepsis.

Methods: Ninety-one patients who were diagnosed with severe sepsis at admission to a surgical intensive care unit were enrolled, and admission plasma gelsolin levels were recorded. Plasma gelsolin levels were recorded daily in 23 of these patients. Daily plasma gelsolin levels were recorded in an additional 15 nonseptic critically ill patients. Fifteen volunteers served as healthy control individuals. Plasma gelsolin levels were measured using an enzyme-linked immunosorbent assay. Concentrations of IL-6, IL-10 and tumour necrosis factor (TNF)-alpha were also measured on intensive care unit admission.

Results: The admission gelsolin levels were significantly decreased in severe sepsis (20.6 +/- 11.7 mg/l) compared with nonseptic critically ill patients (52.3 +/- 20.3 mg/l; P < 0.001) and healthy control individuals (126.8 +/- 32.0 mg/l; P < 0.001). Severe septic patients had increased IL-6 levels compared with nonseptic critically ill patients (20.0 +/- 10.7 pg/ml versus 11.4 +/- 13.9 pg/ml; P = 0.048), whereas no significant difference in IL-10 or TNF-alpha levels was observed (IL-10: 97.9 +/- 181.5 pg/ml versus 47.4 +/- 91.5 pg/ml, respectively [P = 0.425]; TNF-alpha: 14.2 +/- 13.9 pg/ml versus 6.9 +/- 5.3 pg/ml, respectively; P = 0.132). Survivors of severe sepsis exhibited substantial recovery of their depressed plasma gelsolin levels, whereas gelsolin levels in nonsurvivors remained at or below their depleted admission levels.

Conclusion: Plasma gelsolin may be a valuable marker for severe sepsis. Recovery of depleted plasma gelsolin levels correlated with clinical improvement. The prognostic role of plasma gelsolin in critical illness requires further investigation in a large cohort.