download catalog We found a positive association between serum sCD40L levels and platelet count, possibly because platelets are the major source of sCD40L in circulation [4,5]. However, we did not find this association in thrombocytopenic patients, which may be explained by different underlying mechanisms in septic patients [33,34], such as immune destruction by platelet antibodies, hematophagocytosis in the bone marrow, reduced production due to bone marrow depression and non-immune destruction by the interaction of activated platelets with endothelium.We failed to find an association between sCD40L levels and sepsis severity criteria such as lactatemia, APACHE II score, SOFA score, TNF-�� or IL-10 levels. This is in agreement with the results by Nolan et al.

[25] reporting no correlation between sCD40L and the concentrations of IL-6, IL-12 or APACHE II. The lack of correlation may be due to a true absence of relationship or that sCD40L levels are underestimated in more severe disease (for example, dilution, leakage to the intersticial space and urin, increased uptake at sites of inflammation, and so on). In addition, sCD40L would most likely response earlier to changes in inflammatory activity that the APACHE, which is a composite of multiple parameters.Whereas the strength of our study was the relatively large sample size compared with previous reports assessing sCD40L levels in septic patients, some limitations should be recognized. We determined a single testing point for sCD40L levels and we were, therefore, unable to establish the time course of serum sCD40L levels.

Data on other coagulation factors were not analyzed. We determined sCD40 levels only in serum and not in plasma samples to evaluate possible differences due to there has been reported higher sCD40L levels in serum than in plasma levels [35], and in platelet rich plasma than in platelet poor plasma [36,37]. There has been reporting the association Entinostat between sCD40L levels and other cytokines as IL-12 or interferon-gamma; however, we have not explored this possible association [6,38]. Neither, we have explored procalcitonin to determine its association with sCD40L levels. There are been reported an association between sCD40L levels and severity of acute coronary artery syndrome [31] and between troponin and severity of sepsis [39-41]; however, we have not investigated markers of cardiac damage to explore its association with sCD40L levels.

The time until the diagnosis of sepsis can influence the levels of sCD40L observed; however, we have not report it. The serum blood samples for the determination of sCD40L were obtained at moment of sepsis diagnosis and APACHE II was calculated at 24 hours of admission to ICU; thus, we did know if this time-gap can affect in the association between both variables.