Article Figures & Data
- Figure 1
Baseline MPO, SOD, HO-1 and nitrite +nitrate levels according to; septic shock vs non-shock, amputation vs no amputation and RRT vs no RRT. Medians with interquartile ranges are illustrated. HO-1, heme oxygenase-1; MPO, myeloperoxidase; RRT, renal-replacement therapy; SOD, superoxide dismutase.
- Table 1
Patients’ characteristics
Characteristics NSTI, n=80 Age (years) 61 (52—68) Sex, male 52 (65) BMI (kg/m2) 26 (24—31) Comorbidities Cardiovascular disease 35 (44) Chronic kidney disease 5 (6) COPD 6 (8) Diabetes 21 (26) Immune deficiency 2 (3) Liver cirrhosis 1 (1) Malignancy 7 (9) Peripheral vascular disease 11 (14) Rheumatoid disease 4 (5) Polyicrobial versus monomicrobial Monomicrobial infections 30 (37) Polymicrobial infections 42 (53) Negative findings 8 (10) Biochemistry Leukocyte count (109/L) 15 (10–22) C reactive protein (mg/L) 221 (148–324) Creatinine (µmol/L) 109 (78–181) Lactate (mmol/L) 2.3 (1.3–3.3) Other SOFA score* 8 (6–10) SAPS II† 44 (35–51) LRINEC‡ 8 (7–10) Septic shock on admission§ 39 (49) Amputation within 7 days 13 (16) RRT within 7 days 12 (15) Mortality, day 90 12 (15) Continuous data are presented as medians (IQR) and categorical data as absolute numbers (percentage, %).
*SOFA score, day 1; data were missing for three (4%) patients.
†Data were missing for three (4%) patients.
‡Data were missing for eight (10%) patients.
§Septic shock defined as lactate>2 mmol/L and use of vasopressor or inotrope.
BMI, Body Mass Index; COPD, chronic obstructive pulmonary disease; LRINEC, Laboratory Risk Indicator for Necrotizing Fasciitis Score; NSTI, necrotizing soft-tissue infection; RRT, renal-replacement therapy; SAPS II, Simplified Acute Physiology Score II; SOFA, Sequential Organ Failure Assessment.
- Table 2
Effects of HbO2 treatment on ROS and RNS
Plasma ROS/RNS Median difference Immediately before to after HBO2 After HBO2 to follow-up sample All Septic shock Non-shock sepsis All Septic shock Non-shock sepsis MPO (ng/mL) 3.4* ↑ 4.6 3.4* ↑ −11.0* ↓ −14.2* ↓ 1.6 SOD (ng/mL) 8.8* ↑ −1.9 14.4 −19.1** ↓ −24.4* ↓ −10.1* ↓ HO-1 (pg/mL) 17.9 301.3* ↑ −172.3 −11.6 −513.5 65.6 Nitrite+nitrate (µM) 0.05 0.16 0.01 −0.19 0.01 −0.20 Data are compared immediately before and after the first HbO2 treatment session (left), as well as after the first HbO2 treatment session and following day (right). Differences are presented as median differences across the overall cohort (n=80), patients admitted in septic shock (n=39) and patients without septic shock (n=41). Superscripts indicate level of statistical significance performed by Wilcoxon signed-rank test. A positive value indicates significant upregulation (↑); a negative value indicates significant downregulation (↓).
**P<0.05, **P<0.01.
HBO2, hyperbaric oxygen; HO-1, heme oxygenase-1; MPO, myeloperoxidase; RNS, reactive nitrogen species; ROS, reactive oxygen species; SOD, superoxide dismutase.
- Table 3
Spearman rank correlation between severity of disease and baseline ROS and RNS levels
SAPS II SOFA Lactate Rho P value Rho P value Rho P value MPO 0.16 0.15 0.40 <0.001 0.33 0.003 SOD 0.55 <0.001 0.70 <0.001 0.59 <0.001 HO-1 0.35 0.003 0.68 <0.001 0.39 <0.001 Nitrite+nitrate 0.27 0.02 0.25 0.03 0.15 0.19 HO-1, heme oxygenase-1; MPO, myeloperoxidase; RNS, reactive nitrogen species; ROS, reactive oxygen species; SAPS II, Simplified Acute Physiology Score II; SOD, superoxide dismutase; SOFA, Sequential Organ Failure Assessment.
- Table 4
Univariate and multivariate logistic regression analyses of 90-day mortality based on low versus high baseline ROS and RNS levels according to the optimal cut-off values
Unadjusted Adjusted analysis: age and sex Adjusted analysis: age, sex and SOFA Score OR 95% CI P OR 95% CI P value OR 95% CI P value MPO Low
<320.41 Ref. 1 Ref. 1 Ref. High
≥320.41.87 0.37 to 7.62 0.41 1.51 0.28 to 6.55 0.59 0.38 0.04 to 2.26 0.31 SOD Low
<114.91 Ref. 1 Ref. 1 Ref. High
≥114.912.1 2.16 to 226.92 0.02 9.91 1.67 to 190.41 0.04 4.24 0.52 to 92.97 0.23 HO-1 Low
<78911 Ref. 1 Ref. 1 Ref. High
≥78914.88 1.11 to 33.95 0.06 3.66 0.75 to 26.74 0.14 1.14 0.13 to 11.22 0.90 Nitrite+nitrate Low
<18.621 Ref. 1 Ref. 1 Ref. High
≥18.621.48 0.20 to 7.02 0.65 1.73 0.23 to 8.99 0.54 0.94 0.11 to 5.41 0.95 HO-1, heme oxygenase-1; MPO, myeloperoxidase; Ref., reference; RNS, reactive nitrogen species; ROS, reactive oxygen species; SOD, superoxide dismutase; SOFA, Sequential Organ Failure Assessment.
- Table 5
Accuracy of high baseline biomarker (defined by being above the optimal cut-off point) level in predicting 90-day mortality
MPO SOD HO-1 Nitrite+nitrate Sensitivity 0.25
(0.05–0.57)0.92
(0.62–1.00)0.80
(0.44–0.97)0.17
(0.02–0.48)Specificity 0.85
(0.74–0.92)0.52
(0.40–0.65)0.55
(0.42–0.68)0.88
(0.78–0.95)PPV 0.23
(0.05–0.54)0.26
(0.14–0.42)0.22
(0.10–0.39)0.20
(0.03–0.56)NPV 0.85
(0.74–0.92)0.97
(0.85–1.00)0.94
(0.81–0.99)0.86
(0.75–0.93)AUC-ROC 0.48
(0.31–0.66)0.69
(0.51–0.87)0.69
(0.49–0.88)0.61
(0.43–0.79)Data are presented as fractions (95% CI).
AUC-ROC, area under the receiver operating characteristic curve; HO-1, heme oxygenase-1; MPO, myeloperoxidase; NPV, negative predictive value; PPV, positive predictive value; SOD, superoxide dismutase.
Supplementary Materials
Supplementary data
Additional Files
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
