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Byline: Caroline Guignant (1), Nicolas Voirin (2), Fabienne Venet (1), Francoise Poitevin (1), Christophe Malcus (1), Julien Bohe (3), Alain Lepape (3), Guillaume Monneret (1) Keywords: Septic shock; Mortality; Prognosis; Adrenomedullin; Vasopressin Abstract: Purpose Improvements in survival after septic shock will most likely rely on our capacity to manage individualized therapies based on the measurement of rapidly accessible biomarkers. As the early phase of septic shock is dominated by severe alterations of the cardiovascular system, the predictive value for mortality of pro-vasopressin (pro-AVP) and pro-adrenomedullin (pro-ADM), two vasoactive pro-hormones, was assessed. Methods In 99 consecutive patients, pro-hormone concentrations were measured (immunoluminometric assay) three times within the first week after the onset of septic shock. Results Pro-AVP and pro-ADM concentrations were significantly increased in non-survivors in comparison with survivors and were significantly associated with mortality after both univariate and multivariate analysis. Importantly, when assessed as a pair, pro-ADM and pro-AVP were even more informative. Conclusions Both Pro-ADM and pro-AVP appear to be good biomarkers for the prediction of 28-day mortality after septic shock. However, their association in a single variable tends to improve their predictive capacity. Author Affiliation: (1) Flow Cytometry Unit, Immunology Laboratory, Hopital E. Herriot, Hospices Civils de Lyon, 5, Place d'Arsonval, 69437, Lyon cedex 03, France (2) INSERM U271, Hospices Civils de Lyon, Hopital E. Herriot, Service d'Hygiene, Epidemiologie et Prevention, Universite de Lyon, Lyon, France (3) Intensive Care Units, Hospices Civils de Lyon, CH Lyon-Sud, Lyon, France Article History: Registration Date: 21/07/2009 Received Date: 06/01/2009 Accepted Date: 12/05/2009 Online Date: 07/08/2009 Article note: This article is discussed in the editorial available at: doi: 10.1007/s00134-009-1613-2. Electronic supplementary material The online version of this article (doi: 10.1007/s00134-009-1610-5) contains supplementary material, which is available to authorized users.

Byline: F. Leclerc (1), E. Walter-Nicolet (1), S. Leteurtre (1), O. Noizet (1), A. Sadik (1), R. Cremer (1), C. Fourier (1) Keywords: Meningococcal sepsis; Septic shock; Vasopressin; Child Abstract: Objective Vasopressin (AVP) response has been reported to be inappropriately low in adult established septic shock. We studied admission AVP levels in children with meningococcal septic shock (MSS). Patients and methods All children with meningococcal infection admitted to our PICU between May 2001 and August 2002 were classified as MSS (persistent hypotension despite fluid therapy, with perfusion abnormalities and the need for vasoactive drug infusion for at least 24 h or until death), or meningococal infection without shock (fever and purpura, with or without meningitis). Blood samples were collected at admission and AVP levels were subsequently determined using Nichols Institute Diagnostics vasopressin assay. Eighteen of 19 children with MSS (7 deaths) and 15 without shock (no death) were included. Results In children with MSS median admission AVP level was 41.6 pg/ml (1.4--498.9) and in those without 3.3 pg/ml (1.6--63.8). In children with MSS the AVP level was not correlated with duration of shock and fluid expansion prior to AVP sampling, or with age-adjusted blood pressure and natremia at the time of blood sampling. AVP levels were higher in nonsurvivors, but not significantly so. Only one nonsurvivor had an admission AVP level below 30 pg/ml. Conclusions In our children with established MSS who died the admission AVP level I were not inappropriately low. Further studies including serial AVP level assessments are needed before concluding that AVP administration is of little interest in children with MSS. Author Affiliation: (1) Service de Reanimation Pediatrique, Hopital Jeanne de Flandre, avenue Eugene Avine, 59037, Lille, France Article History: Received Date: 06/01/2003 Accepted Date: 23/05/2003 Online Date: 10/07/2003