Circulating endothelial progenitor cells may predict outcomes in adult patients with severe sepsis in the emergency department

Background: Dysfunctional and decreased numbers of endothelial progenitor cells (EPCs) may play an essential role in the initiation of organ dysfunction caused by severe sepsis. We evaluated the role of serial circulating EPCs in outcomes of patients with severe sepsis. Methods: In total, 101 adult patients with severe sepsis and septic shock were evaluated. Circulating levels of EPCs (CD133(+)/CD34(+) and KDR+/CD34(+) cells) were determined at different time points. Results: The levels of CD133(+)/CD34(+) and KDR+/CD34(+) EPCs were significantly higher in the severe sepsis group than in the healthy controls. Levels of CD133(+)/CD34(+) EPCs were significantly higher in the mortality group than in the survival group on day 1 of admission (p < 0.05), but decreased significantly with time among non survivors (p < 0.05), and were lowest on day 4 at the emergency department. The Sequential Organ Failure Assessment score and number of CD133+/CD34+ EPCs on admission were independently associated with in-hospital mortality. Conclusion: The level of CD133+/CD34+ EPCs on admission is independently associated with in-hospital mortality, and the trend of a sharp decrease in the number of EPCs is related to outcomes in patients with severe sepsis. (C) 2016 Elsevier B.V. All rights reserved.