Extracellular heat shock protein 70 is a mortality predictor in patients with septic shock and is associated with the APACHE II and SOFA scores, and the pro‑inflammatory immune response

The aim of the present study was to determine the association between extracellular heat shock protein (eHsp70) levels with mortality in adult patients with septic shock, as well as the association between eHsp70 levels and the APACHE II and SOFA scores, and the cytokines inflammatory response. The present study was an observational, longitudinal, prospective, cohort study. Adult patients with septic shock admitted to the intensive care unit (ICU) were included in the study; the eHsp70 levels were measured in sera by ELISA, and the APACHE II and SOFA scores were determined upon admission and every two days until death or discharge for improvement. The levels of pro-inflammatory cytokines were measured at baseline and at discharge. A total of 90 patients were included, 53 males and 37 females. In total, 50% (n=45) patients succumbed to the disease. Upon admission to the ICU, the eHsp70 levels (mean [+ or -] SE) were higher in the deceased patients (1,963[+ or -]461.9) compared with those in the survivors (1,499[+ or -]482.0, P=0.02). ROC curve analysis for predicting mortality revealed that the eHsp70 concentration during admission to the ICU exhibited an area under the curve of 0.63, despite Kaplan-Meier analysis, which revealed that the two higher quartiles of Hsp70 levels predicted an early mortality. Higher APACHE II and SOFA scores, as well as interleukin (IL)-6 (2,229[+ or -]687 vs. 1,116[+ or -]441, P=0.03), IL-8 (995[+ or -]310 vs. 206[+ or -]88, P=0.005) and IL-18 (1,482[+ or -]314 vs. 664[+ or -]150, P=0.001) levels were found in the deceased patients. Thus, the present study demonstrates that high levels of eHsp70, and high APACHE II and SOFA scores, as well as a higher pro-inflammatory response is associated with mortality. eHsp70 may thus prove to be a marker of severity in adult patients with septic shock.