• T Tavladaki, A V Kozlov, A M Spanaki, J C Duvigneau, H Dimitriou, A Weidinger, E Kondili, D Georgopoulos, and G Briassoulis.
• 1PICU, University of Crete/University Hospital, Heraklion, Greece 2Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA, Vienna, Austria 3University of Veterinary Medicine, Vienna, Austria 4Paediatric Haematology Oncology, University of Crete, Medical School, Heraklion, Greece 5ICU, University of Crete/University Hospital, Heraklion, Greece.
• Shock. 2015 Oct 1;44 Suppl 2:14.

IntroductionSystemic inflammation is associated with an excessive production of nitric oxide (NO), which interferes with a number of metabolic pathways, including mitochondrial ATP synthesis.MethodsWe examined seventy-eight adult patients (severe sepsis (SS)/22; non-infectious systemic inflammatory response (SIRS)/23; healthy (H)/33). Energy expenditure (EE) was determined by the Gas Module E- COVX in order to define metabolic activity. HSPs expressions and ATP levels in white blood cells were determined by flow cytometry and luciferase luminescent assay, respectively. The levels of amino acids and NO2/NO3 in plasma were determined by HPLC and Sievers NO-Analyzer, respectively.ResultsSS and SIRS patients predominantly manifested hypometabolic (SS 41%, SIRS 65%) or hypermetabolic (SS 41%, SIRS 17.4%) rather than normometabolic pattern (SS 18.2% vs. 17.4%). The hypometabolic pattern was associated with increased mortality (p < 0.01); accompanied by decreased concentrations of amino acids (p < 0.04) and HSP72 expression (p < 0.03). Patients with SS had lower ATP (184 ± 133 vs. 895 ± 863 nM) and NO2 (211 ± 56 vs. 280 ± 53 nM, p < 0.03) levels, while SIRS patients lower NO3/NO2 (p < 0.02) compared to controls. SS had repressed HSP72 (p < 0.01), decreased SID (p < 0.03) and increased NO3 levels (p < 0.01) compared to SIRS. ATP was correlated with glutamine (p < 0.05), NO2 with citruline (p < 0.03) and glucine (p < 0.05), and NO3 with the metabolic pattern (p < 0.05), CRP (p < 0.02), SAPS3 (p < 0.02) and inversely with pH (p < 0.002).ConclusionThe patterns of NO metabolites in plasma suggest that the changes in ATP and HSP72 are linked to NO metabolism and play a key role in the regulation of metabolic activity and outcome of the patients.AcknowledgementSupported by EU-ESF and NSRF-THALES.

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