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Dadun > Depósito Académico > CIMA (Centro de Investigación Médica Aplicada) > Área de Ciencias Cardiovasculares > Aterosclerosis e inflamación > DA - CIMA - Cardiovasculares - Aterosclerosis e inflamación - Artículos de revista >

Association between serum soluble CD40 ligand levels and mortality in patients with severe sepsis
Authors: Lorente, L. (Leonardo)
Martin, M.M. (María M.)
Varo, N. (Nerea)
Borreguero-Leon, J.M. (Juan María)
Sole-Violan, J. (Jordi)
Blanquer, J. (José)
Labarta, L. (Lorenzo)
Diaz, C. (César)
Jimenez, A. (Alejandro)
Pastor, E. (Eduardo)
Belmonte, F. (Felipe)
Orbe, J. (Josune)
Rodriguez, J.A. (José Antonio)
Gomez-Melini, E. (Eduardo)
Ferrer-Agüero, J.M. (José M.)
Ferreres, J. (José)
Llimiñana, M.C. (María C.)
Paramo, J.A. (José Antonio)
Keywords: Sepsis
CD40 ligand
Issue Date: 2011
Publisher: BioMed Central
Publisher version:
ISSN: 1466-609X
Citation: Lorente L, Martin MM, Varo N, Borreguero-Leon JM, Sole-Violan J, Blanquer J, et al. Association between serum soluble CD40 ligand levels and mortality in patients with severe sepsis. Crit Care 2011 Mar 15;15(2):R97.
INTRODUCTION: CD40 Ligand (CD40L) and its soluble counterpart (sCD40L) are proteins that exhibit prothrombotic and proinflammatory properties on binding to their cell surface receptor CD40. The results of small clinical studies suggest that sCD40L levels could play a role in sepsis; however, there are no data on the association between sCD40L levels and mortality of septic patients. Thus, the aim of this study was to determine whether circulating sCD40L levels could be a marker of adverse outcome in a large cohort of patients with severe sepsis. METHODS: This was a multicenter, observational and prospective study carried out in six Spanish intensive care units. Serum levels of sCD40L, tumour necrosis factor-alpha and interleukin-10, and plasma levels of tissue factor were measured in 186 patients with severe sepsis at the time of diagnosis. Serum sCD40L was also measured in 50 age- and sex-matched controls. Survival at 30 days was used as the endpoint. RESULTS: Circulating sCD40L levels were significantly higher in septic patients than in controls (P = 0.01), and in non-survivors (n = 62) compared to survivors (n = 124) (P = 0.04). However, the levels of CD40L were not different regarding sepsis severity. Logistic regression analysis showed that sCD40L levels >3.5 ng/mL were associated with higher mortality at 30 days (odds ratio = 2.89; 95% confidence interval = 1.37 to 6.07; P = 0.005). The area under the curve of sCD40L levels >3.5 ng/mL as predictor of mortality at 30 days was 0.58 (95% CI = 0.51 to 0.65; P = 0.03). CONCLUSIONS: In conclusion, circulating sCD40L levels are increased in septic patients and are independently associated with mortality in these patients; thus, its modulation could represent an attractive therapeutic target.
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