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Time-course of sFlt-1 and VEGF-A release in neutropenic patients with sepsis and septic shock: a prospective study


Background: Febrile neutropenia carries a high risk of sepsis complications, and the identification of biomarkers capable to identify high risk patients is a great challenge. The VEGF/sFlt-1 axis is associated with the control of the integrity of the endothelial barrier function during embryonic angiogenesis. REcently, VEGF levels have been associated with mortality in intensive care units. Regarding sFlt-1m there are only pre-clinical data about its role in sepsis. sFlt-1 acts as a decoy receptor of VEGF. Methods: We prospectively evaluated concentrations of sFlt-1 and VEGF at different time-points during febrile neutropenia, and explored the diagnostic accuracy of these mediators as potential predictors of poor outcome in this clinical setting before the development of sepsis complications . Results: Patients that evolved with septic shock (n=10) presented higher levels of sFlt-1 and VEGF measured 48 hours after fever onset compared to patients with non-complicated sepsis (n=31).These levels correlated with sepsis severity scores. Conclusions: Our data suggest these proteins can be useful biomarkers of the risk of developing septic shock in febrile neutropenia. Larger studies are warranted to validate their clinical usefulness. Therapeutic strategies that manipulate sFlt-1 levels can potentially offer new and promising treatments for sepsis in febrile neutropenia. (AU)

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