NITRIC-OXIDE (NO) PRODUCTION CORRELATES WITH RENAL-INSUFFICIENCY AND MULTIPLE ORGAN DYSFUNCTION SYNDROME IN SEVERE SEPSIS

Objective: To investigate whether the production of nitric oxide (NO) relates to the development of renal insufficiency and multiple organ d ysfunction syndrome (MODS) in patients with severe sepsis. Design: Pro spective study in 23 patients with severe sepsis. Setting. Medical and surgical intensive care units (ICU) of three hospitals. Measurements and results. Serum nitrate levels, as an indirect parameter of the pro duction of NO in vivo, and scores for renal insufficiency and MODS wer e determined in patients with severe sepsis during a 1-week period aft er admission to the ICU. The highest serum nitrate levels were found a t 4 h (mean 52 +/- 16 mu mol/l) after entry into the study and the lev els gradually declined thereafter. Patients with renal insufficiency h ad considerably higher serum nitrate levels during the study period th an patients who did not develop renal insufficiency (MANOVA, p < 0.05) . Serum nitrate levels correlated with scores for renal insufficiency (r = 0.60, p < 0.001), and far exceeded the levels that can be explain ed solely by reduced renal clearance of nitrate. Further analysis show ed that serum nitrate levels significantly and positively correlated w ith scores for MODS (r = 0.44, p < 0.001). Conclusion: Our results ind icate that the production of NO correlates with renal insufficiency an d MODS in patients with severe sepsis and that this reactive nitrogen intermediate could be involved in the pathogenesis of organ failure in these critically ill patients.