Endogenous nitric oxide production and hemodynamic abnormalities in children with sepsis syndrome

Abstract EN

Background:The aim of this study was to find a correlation between the level of endogenous nitric oxide production and the hemodynamic abnormalities in patients with sepsis syndrome and their role in the development of multiple organ dysfunction syndrome and to evaluate the role of neutrophils in nitric oxide production in septic patients.

Aims: it aimed also to correlate the level of nitric oxide and the vascular responsiveness to inotropic agents namely dopamine and dobutamine.

Methods: The study included thirty patients with sepsis due to different causes.

Patient age ranged between 2 months to 7 years who were admitted to the intensive care unit, New children Hospital, Cairo University (from January 2006 to October 2006).

Ten sex and age matched healthy children will constitute the control group.

Venous blood samples were collected on the admission to the hospital and 2 days later for measurement of total serum nitrite.

Results:_Blood culture with positive results were found in 25 patients.

We measured the concentration of serum nitrites, the markers of nitric oxide synthesis, in patients with sepsis syndrome on their admission day and comparing them to healthy children.

We found an increased mean serum nitrite concentrations in patients with sepsis syndrome (121.81 + 86.21u,mol/L with a significant P value < 0.05) compared to healthy children (62.71 + 23.41 Hmol/L).

Sepsis syndrome patients with hypotension showed significantly (P < 0.05) higher concentrations of total serum nitrite on admission day (174.41 ± 71.23) compared with control group (62.71 ± 23.41) (table 3).

Sepsis syndrome patients with multiple system failure showed significantly (P < 0.05) higher concentrations of total serum nitrites (175.83 + 71.21) on admission day compared with control group (62.71 + 23.41) (Table 3).

The results of the study also showed significant increased level of total serum nitrite in patients with septic syndrome who had normal neutrophils (159.85+ 61.20u.mol/L on admission) compared to those with neutropenia (83.77+ 42.21u,mol/L).

The difference is also significant.

Conclusion: Our study confirmed that a hyperproduction of nitric oxide may contribute to hypotension, cardiac depression and vascular hypo-reactivity to inotropes in patients with sepsis synchome.

It showed that neutrophils are also known to play a part in nitric oxide production in patient with sepsis syndrome and that excessive nitric oxide production could be involved in the development of multiple organ dysfunction syndrome.