Pauline Hadisiswoyo, Endang Retnowati, Erwin Astha Triyono


A widely used scoring system to assess the severity of sepsis is Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring system, however there are some disadvantages in using this. Other parameters are needed to predict severity and outcome of sepsis. Proinflammatory cytokines and Fas receptors are increased in sepsis and their concentration elevations are correlated with disease severity. An increase of soluble Fas level will follow increasing Fas receptors. This study aimed to prove any correlation between the level of soluble Fas and degree of sepsis severity based on APACHE II score. A cross-sectional observational study was conducted in January-June 2015 on 30 septic patients. APACHE II scores were calculated from the patients’physiological data, age, and chronic health problem status. Levels of soluble Fas were measured using the ELISA method (Human FAS/ CD95 (Factor-Related Apoptosis) ELISA Kit, Elabscience Biotechnology). Levels of soluble Fas ranged between 1,049-2,783 pg/mL (1,855.7 ± 477.27 pg/mL). APACHE II scores varied between 4-29 (17.2 ± 5.82). Significant positive correlations between levels of soluble Fas and APACHE II score (r=0.347, p=0.03) were found. A prediction model of soluble Fas levels based on APACHE II score was made. Linear regression analysis produced a prediction model of soluble Fas levels based on APACHE II score, in which soluble Fas level= 1,365.8 + 28.485 x APACHE II score.




Sepsis, soluble Fas, APACHE II score

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mechanisms in septic shock. Laboratory Investigation. 2014; 94:4-12.

Martin GS. Sepsis, severe sepsis and septic shock: Changes in incidence, pathogens and outcomes. Expert Review of Anti-Infective Therapy. 2012; 10:701-06.

Indonesia Research Partnership on Infectious Disease. Sepsis study. 2014 [cited 2014 Oct 15]. Available from:

Bozza FA, Salluh JI, Japiassu AM, Soares M, Assis EF. Cytokine profiles as markers of disease severity in sepsis: A multiplex analysis. Critical Care. 2007; 11(2): R49.

Wax RS, Angus DC, Knaus W. Quantifying risk in sepsis: A review of illness severity and organ dysfunction scoring. The sepsis text. New York, Kluwer Academic Publishers, 2002; 81-92.

Ho KM, Lee KY, Williams T, Finn J, Knuimann M, Webb SAR. Comparison of acute physiology and chronic health evaluation (APACHE) II score with organ failure scores to predict hospital mortality. Anesthesia. 2007; 62: 466-73.

Handayani D, Arief N, Swidarmoko B, Astowo P, Dahlan MS. Sistem skor acute physiology and chronic health evaluation (APACHE) II sebagai prediksi mortalitas pasien rawat instalasi perawatan intensif. Jurnal Respirologi Indonesia. 2014; 34(1): 36-45.

Giamarellos-Bourbolis EJ, Norby-Teglund A, Mylona V, Sawa A, Tsangaris I. Risk assessment in sepsis: A new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor. Critical Care Medicine. 2012; 16(4): R149.

Goral V, Berekatoglu N, Mete N. Correlation of disease activity, IL-6 & CRP levels and leukocytes/ lymphocyte ratio among patients with acute pancreatitis. Journal of Gastrointestinal & Digestive System. 2012; 2(3): 112-5.

Wilson WC, Grande CM, Hoyt DB. Trauma: critical care. 2nd Ed., London, CRC Press, 2007; 70-75.

Fleck M, Reng M, Mountz JD. Significantly elevated levels of soluble Fas (CD95/ Apo-1) in sera of septic shock. Shock. 2000; 13: A457.

Mikic D, Vasilijic S, Cucuz M, Colic M. Clinical significance of soluble Fas plasma levels in patients with sepsis. Vojnosanitetski Pregled. 2014; 10:1-6.

Billiau A, Vandekerckhove A. Cytokines and their interactions with other inflammatory mediators in the pathogenesis of sepsis and septic shock. European Journal of Clinical Investigations. 1991; 21(6): 559-73.

Marsik C, Halama T, Cardona F, Wilhelm W, Florian M, et al. Regulation of Fas (Apo-1, CD95) and Fas ligand expression in leukocytes during systemic inflammation in humans. Shock. 2003; 20(6): 493-96.

Sahebari M, Hatef MR, Rezaieyazdi Z, Abbasi M, Abbasi B, Mahmoudi M. Correlation between serum levels of soluble Fas (CD95/Apo-1) with disease activity in systemic lupus erythematosus patients in Khorasan, Iran. Archives of Iranian Medicine. 2010; 13(2): 135-42.

Paunel-Gorgulu A, Flohe S, Scholz M, Windolf J, Logters T. Increased serum soluble Fas after major trauma is associated with delayed neutrophil apoptosis and development of sepsis. Critical Care. 2011; 15(1): R20.

Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin G. The role of infection and comorbidity: factors that influence disparities in sepsis. Critical Care Medicine. 2006; 34(10): 2576-82.

Angele MK, Pratschke S, Hubbard WJ, Chaudry IH. Gender differences in sepsis: Cardiovascular and immunological aspects. Virulence. 2014; 5(1): 12-19.

Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, Kurosawa S, Stepien D, et al. Sepsis: Multiple abnormalities, heterogenous responses and evolving understanding. Physiological Reviews. 2013; 93: 1247-88.

De Freitas I, Fernandez-Somoza M, Essenfeld-Sekler E, Cardier J. Serum levels of the apoptosis-associated molecules, tumor necrosis factor-α/tumor necrosis factor type-I receptor and Fas/ FasL, in sepsis. Chest. 2004; 125(6): 2238-46.

Torre D, Tambini R, Manfredi M, Mangani V, Livi P, et al. Circulating levels of FAS/APO-1 in patients with the systemic inflammatory response syndrome. Diagnostic Microbiology and Infectious Disease. 2003; 45: 233-36.

Manganaro L, Stark M. APACHE foundations user guide. Cerner Corporation. 2010; 1-49.

Hinkle DE, Wiersma W, Jurs SG. Applied statistics for behavioral sciences. 5th Ed., Boston, Houghton Mifflin, 2003; 34-38.



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