Diagnostic and Prognostic Role of VEGF in Critically ill Pediatric Patients with Sepsis and Sepsis Induced Capillary Leak Syndrome

Abstract

Objectives: Vascular endothelial growth factor (VEGF) is a potent vascular permeability factor. The development of capillary leak is common in septic patients, and several sepsis-associated mediators may induce VEGF production. The potential role of VEGF during sepsis has not been studied to date. The aim of the study was first to assess whether circulating VEGF levels increase during sepsis, and second, to examine whether plasma VEGF levels are associated with disease severity and sepsis induced capillary leak syndrome. Patients and methods : A prospective randomized trial was conducted on 40 children who were divided into two groups; the first group contained 20 healthy children , and the other group contained 20 septic children . one plasma sample was obtained from each child of the first group, and two plasma samples from each child of the second group , the first sample before occurrence of sepsis induced capillary leak syndrome and the second sample after occurrence of sepsis induced capillary leak syndrome, VEGF levels were measured in all plasma samples obtained from the 40 children. VEGF levels were correlated to clinical signs and symptoms. Results: plasma VEGF levels were significantly elevated in patients with severe sepsis versus controls (182.45±81.54pg/mL vs. 24.2± 11.14; P< 0.001). and There was significant increase in VEGF level in septic patient after development of Sepsis Induced Capillary Leak Syndrome (295.20 ± 105.29 pg/mL vs. 182.45± 81.54; P< 0.001). The septic patients in our study population showed signs of generalized vascular leakage, such as decreased serum albumin values. also Maximum VEGF levels during the course of disease were higher in non-survivors than in survivors (345 ± 91.92pg/mL vs. 164.39± 59; P<0.001), These findings clearly indicate that VEGF levels are negatively associated with outcome. Conclusions: These data show that plasma VEGF levels are elevated during severe sepsis, and elevated more after occurrence of sepsis induced capillary leak syndrome . Furthermore, our data indicate that plasma VEGF levels are associated with disease severity and mortality.