Prognostic significance of the angiopoietin-2/angiopoietin-1 and angiopoietin-1/Tie-2 ratios for early sepsis in an emergency department

INTRODUCTION This study was performed to assess the early diagnostic, risk stratification, and prognostic value of the angiopoietin-2/angiopoietin-1 ratio (Ang-2/Ang-1) and angiopoietin-1/tyrosine kinase with immunoglobulin-like loop epidermal growth factor homology domain 2 ratio (Ang-1/Tie-2) and to compare these factors with procalcitonin (PCT) and the Mortality in Emergency Department Sepsis (MEDS) score in patients with early sepsis in the emergency department (ED). METHODS Consecutive patients with sepsis (n = 440) were enrolled in this study. They fulfilled the systemic inflammatory response syndrome (SIRS) criteria and were admitted to the ED of Beijing Chao-yang Hospital between August 2014 and February 2015. The control group consisted of 55 healthy blood donors. The patients were categorized into four groups: SIRS, sepsis, severe sepsis, and septic shock. Serum Ang-1, Ang-2, Tie-2, and PCT were measured, and the MEDS score was calculated upon ED arrival. The prognostic values of Ang-2/Ang-1, Ang-1/Tie-2, Ang-1, Ang-2, and Tie-2 were compared with the PCT and MEDS scores. All patients were followed for 28 days. RESULTS Upon admission, the median levels of the serum Ang-2 level and Ang-2/Ang-1 ratio increased and the serum Ang-1 levels and Ang-1/Tie-2 ratios decreased with the severity of sepsis. The areas under the receiver operating characteristic curves of the Ang-2/Ang-1 and Ang-1/Tie-2 ratios were greater than those of the Ang-1, Ang-2, and PCT levels and MEDS scores in the diagnosis and prediction of 28-day mortality due to sepsis. Ang-2/Ang-1 was significantly higher and Ang-1/Tie-2 was significantly lower in nonsurvivors than in survivors at the 28-day follow-up examination. Ang-2/Ang-1, Ang-1/Tie-2, and MEDS score were found to be independent predictors of 28-day mortality in patients with sepsis. The levels of serum Ang-1, Ang-2, and Tie-2 were positively correlated with each other. The ratios of Ang-2/Ang-1 and Ang-1/Tie-2 were positively and negatively correlated, respectively, with the MEDS score in every septic group. CONCLUSIONS The Ang-2/Ang-1 and Ang-1/Tie-2 ratios are valuable for risk stratification in patients with sepsis and are associated with the poor clinical outcome of early sepsis in the ED.