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00925njm 22002777a 4500 dc Martín Fernández, Marta author Vaquero Roncero, Luis Mario author Almansa Mora, Raquel author Gómez Sánchez, Esther author Martín, Silvia author Tamayo Gómez, Eduardo author Esteban Velasco, María Carmen author Ruiz Granado, Patricia author Aragón, Marta author Calvo, Dolores author Rico Feijoo, Jesús author Ortega, A. author Gómez Pesquera, Estefanía author Lorenzo López, Mario author López Sánchez, Jaime author Doncel, Cristina author González Sánchez, Carmen author Álvarez, D. author Zarca, E. author Ríos Llorente, Alberto author Díaz Álvarez, A. author Sánchez Barrado, Elisa author Andaluz Ojeda, David author Calvo Vecino, José María author Muñoz Bellvís, Luis author Gómez Herreras, José Ignacio author Abad Molina, Cristina author Bermejo Martín, Jesús Francisco author Aldecoa Álvarez Santullano, César Enrique author Heredia Rodríguez, María author 2020 Background: Stratification of the severity of infection is currently based on the Sequential Organ Failure Assessment (SOFA) score, which is difficult to calculate outside the ICU. Biomarkers could help to stratify the severity of infection in surgical patients. Methods: Levels of ten biomarkers indicating endothelial dysfunction, 22 indicating emergency granulopoiesis, and six denoting neutrophil degranulation were compared in three groups of patients in the first 12 h after diagnosis at three Spanish hospitals. Results: There were 100 patients with infection, 95 with sepsis and 57 with septic shock. Seven biomarkers indicating endothelial dysfunction (mid-regional proadrenomedullin (MR-ProADM), syndecan 1, thrombomodulin, angiopoietin 2, endothelial cell-specific molecule 1, vascular cell adhesion molecule 1 and E-selectin) had stronger associations with sepsis than infection alone. MR-ProADM had the highest odds ratio (OR) in multivariable analysis (OR 11·53, 95 per cent c.i. 4·15 to 32·08; P = 0·006) and the best area under the curve (AUC) for detecting sepsis (0·86, 95 per cent c.i. 0·80 to 0·91; P < 0·001). In a comparison of sepsis with septic shock, two biomarkers of neutrophil degranulation, proteinase 3 (OR 8·09, 1·34 to 48·91; P = 0·028) and lipocalin 2 (OR 6·62, 2·47 to 17·77; P = 0·002), had the strongest association with septic shock, but lipocalin 2 exhibited the highest AUC (0·81, 0·73 to 0·90; P < 0·001). Conclusion: MR-ProADM and lipocalin 2 could be alternatives to the SOFA score in the detection of sepsis and septic shock respectively in surgical patients with infection. BJS Open, 2020, vol. 4, n. 3. p. 524-534 2474-9842 http://uvadoc.uva.es/handle/10324/45461 10.1002/bjs5.50265 Endothelial dysfunction is an early indicator of sepsis and neutrophil degranulation of septic shock in surgical patients