ENDOCAN DYNAMICS IN SEPSIS

PASTIENTS

Department of Internal Medicine, Faculty of Medicine

Hasanuddin University
2019
 BACKGROUND

SEPSIS

Sepsis arises when the body’s response to an infection injures its own
tissues and organs

Sepsis potentially leading to death or significant morbidity

Estimated to affect more than 30 million people worldwide every

year, potentially leading to 6 million deaths

Badan Penelitian dan Pengembangan Kesehatan Kementrian Kesehatan RI. Riset kesehatan dasar 2013. 2013. Hal. 65
 BACKGROUND

Biomarkers can be used to determine sepsis

Some studies have shown that endocan is a biomarker for

endothelial dysfunction and multiorgan failure in sepsis and can
determine the prognosis in sepsis

SOFA (Sequential (Sepsis-related) Organ Failure Assessment) is a

scoring method to identify the of organ dysfunction in sepsis

Pierrakos C, Vincent JL. Sepsis biomarkers: a review. Pierrakos and Vincent Critical Care. 2010; 14: R15.
Mervyn S, Clifforf S, Cristopher W, et al. The Third internasional consensus definiyions for sepsis and septic shock(septic-3). 2016.
315(8):801-810.
 Problem

How Endocan Dynamics In Sepsis Patients

GENERAL AIM

Knowing dynamics endocan in sepsis patients

SPECIFIC AIM
Knowing endocan determining the prognosis in sepsis
patients

Knowing SOFA score determining the prognosis in

sepsis patients
STUDY BENEFIT

Provide information about dynamics endocan in sepsis patients so that it

can be used as a reference for further research.
 LITERATURE REVIEW

SEPSIS
Sepsis arises when the body’s response to an infection injures its own
tissues and organs

Gotts JE, Mathay MA. Sepsis: pathopysiology and clinical management. BMJ. 2016; 353:i1585.
 PATHOPHYSIOLGY

Gotts JE, Mathay MA. Sepsis: pathopysiology and clinical management. BMJ. 2016; 353:i1585.
 LITERATURE REVIEW

BIOMARKER FOR SEPSIS

PATIENTS
Tests for sepsis are white blood cell (WBC) examination, blood
culture and lactate test

In addition, some biomarkers are also a diagnostic for sepsis like

endocan

Pramod J, Singh A. Departement of Pulmonary Medicine Christian Medical College and Hospital. India.
doi:10.1016/j.amjmed.2007.12.009
Biron BM, Ayala A, Nei ra JLL. Biomarker for sepsis: what is and what might be?. Biomarker Insights. 2015; 10(S4): 7-17.
 LITERATURE REVIEW

ENDOCAN

Endothelial cell-specific molecule-1 (ESM-1), commonly known as endocan, is a

soluble proteoglycans expressed by vascular endothelium.
Based on experiments, endocans are regulated by the stimulation of
proinflammatory cytokines
endocan release in response to inflammatory stimulation are regulated endothelial /
leukocyte cell interactions
Endocan increases in sepsis patients due to the release of inflammatory factors

Biron BM, Ayala A, Nei ra JLL. Biomarker for sepsis: what is and what might be?. Biomarker Insights. 2015; 10(S4): 7-17.
Yang J, Yang Q, Yu S, Zhang X. Endocan: a new marker for cancer and a target for cancer therapy. Biomedical reports. 2015;
3: 279-283.
 LITERATURE REVIEW

SOFA (Sepsis-related) Organ

Failure Assessment)

SOFA (Sepsis-related) Organ Failure Assessment) is a scoring method used to

determine organ dysfunction in sepsis.
SOFA score ≥2 indicates organ dysfunction.

A study concluded that sepsis patients who died had higher SOFA scores than sepsis
patients who did not die

Biron BM, Ayala A, Nei ra JLL. Biomarker for sepsis: what is and what might be?. Biomarker Insights. 2015; 10(S4): 7-17.
Yang J, Yang Q, Yu S, Zhang X. Endocan: a new marker for cancer and a target for cancer therapy. Biomedical reports. 2015;
3: 279-283.
 SOFA SCORE

A study concluded that endocan is increased in patients with organ

dysfunction in sepsis patients. Organ dysfunction can be identified using
SOFA scores

Dunja M,Dajana F,Gorana P, et al. Endocan is useful biomarker of survival and severity sepsis. 2014. 93 : 92-97.
 THEORETICAL FRAMEWORK

Pulmonary TB

Cytokine proinflammatory

Hepatic acute-phase response

Altered level of coagulant plasma

Increased Fibrinogen, D- Decreased antithrombin

dimer, prolonged PT and III and Protein C and
aPTT, reactive thrombosis Protein S

Hypercoagulability state
 CONCEPTUAL FRAMEWORK

Independent Pulmonary TB
Variable

• Age
• Obsesity
• DM
• Smoking

PT, aPTT, Fibrinogen, Dependent

D-dimer variable
 HYPOTHESIS

• PT value will be more prolonged in new patients

of pulmonary TB than in healthy subject
• aPTT value will be more prolonged in new
patients of pulmonary TB than in healthy subject
• Fibrinogen levels will be higher in new patients of
pulmonary TB than in healthy subject
• D-dimer levels will be higher in new patients of
pulmonary TB than in healthy subject
 STUDY METHOD

Study design Analytic research with cross sectional design.

Clinic Pulmonolgy Makassar and Dr. Wahidin Sudirohusodo

Place and time Hospital and it’s network
Until the sample is fulfilled.

Population Healthy subject and new patients pulmonary TB

Study population that meet the inclusion and

Study subject exclusion criteria.

Sampling Consecutive sampling

method
 STUDY METHOD

Inclusion Criteria Exclusion Criteria

Have been received anti tuberculosis

Age ≥ 18 y.o drugs within 1 month/28 dosage

Patients with autoimmune diseases

Newly diagnosed pulmonary TB

Patients with cardiovascular diseases
patients

Patients who are taking anticoagulant

or immunosupression drugs
Patients are willing to participate in
the study and sign informed consent. Pregnancy, Malignancy,
Immobilization
 SAMPLE

Estimated number of research samples calculated using the formula:

n = 2PI2 p (1- p )
(p1 - p2) 2

Description:
N= Estimated population to be studied
PI = power index = 0.84
P = (P1 + P2) : 2
P1 = The proportion of non TB
P2 = The proportion of new patients of pulmonary TB

Using this formula the number of samples obtained at least 60 samples.

WORKING PROCEDURE

Healthy subject and new patients pulmonary TB, whether they are outpatient or
hospitalized will be given an explanation of the disease and if willing to take part in
the study sign an informed consent.

History taking, physical examination, routine blood laboratory

examination, blood chemistry.
Reasearch permit and Ethical Eligibility

In carrying out this research, each action was carried out with
the permission and knowledge of the patient which was made
into a research sample through an informed consent sheet and
stated to fulfill ethical requirements to be implemented from the
Biomedical Research Commission on Humans Faculty of
Medicine Hasanuddin University
Operational Definition & Objective Criteria

Pulmonary TB

Infections in the lungs caused by the Mycobacterium tuberculosis

Objective criteria :
Growth of M.tb in culture; 2 of 3 sputum examinations of smear
acid-fast bacilli are positive, if negative diagnosis can be made
clinically, clinical examination and investigation such as chest X-
ray
Operational Definition & Objective Criteria

Healthy subject

individual who is not known to suffer of any significant illness

relevant to the proposed study, who should be within the
ordinary range of body measurements, such as weight, and
whose mental state is such that he is able to understand and give
valid consent to the study
Operational Definition & Objective Criteria

New patients of pulmonary TB

Patients who have never received TB treatment before or have

taken anti-tuberculosis drugs but less than 1 month ( <28 dosage
).
Operational Definition & Objective Criteria

Age

A unit of time to measure human existence

based on the date of birth of the respondent listed on the

medical record that matches the identity card
Operational Definition & Objective Criteria

Hypercoaguabilty state

The tendency to have thrombosis as a result of certain inherited

and/or acquired molecular defects.

Hypercoagulability occurs when there is an increase in levels of

procoagulant (fibrinogen, D-dimer, PT, aPTT) and decreased levels
of anticoagulants (antithrombin III, Protein S, Protein C)
DATA ANALYSIS

The data obtained were analyzed using the

Statistical Package for Social Science (SPSS)
program version 22.
 RESEARCH ALGORHYTHM

Population study

History taking,
Physical
examination

Inverstigation
New patient of
Healthy subject pulmonary TB
PT, aPTT, Fibrinogen, D-dimer

Collecting data

Data analysis

Study result
THANK YOU