• Peter A Abdelmalik, Robert D Stevens, Sarabdeep Singh, John Skinner, J Ricardo Carhuapoma, Sanjeev Noel, Roger Johns, and Ralph J Fuchs.
• Department of Neurology, State University of New York, University at Buffalo, Buffalo, NY 14202, United States. Electronic address: peterabd@buffalo.edu.
• J Crit Care. 2018 Apr 1; 44: 323-330.

PurposeGenetic deletions decreasing serum alpha-Klotho (alpha-KL) have been associated with rapid aging, multi-organ failure and increased mortality in experimental sepsis. We hypothesized that lower alpha-KL obtained at the onset of septic shock correlates with higher mortality.Materials And MethodsProspective cohort of 104 adult patients with septic shock. Alpha-KL was measured via ELISA on serum collected on the day of enrollment (within 72h from the onset of shock). Relationship between alpha-KL and clinical outcome measures was evaluated in uni- and multi-variable models.ResultsMedian (IQR) alpha-KL was 816 (1020.4) pg/mL and demonstrated a bimodal distribution with two distinct populations, Cohort A [n=97, median alpha-KL 789.3 (767.1)] and Cohort B [n=7, median alpha-KL 4365.1(1374.4), >1.5 IQR greater than Cohort A]. Within Cohort A, ICU non-survivors had significantly higher serum alpha-KL compared to survivors as well as significantly higher APACHE II and SOFA scores, rates of mechanical ventilation, and serum BUN, creatinine, calcium, phosphorus and lactate (all p≤0.05). Serum alpha-KL≥1005, the highest tertile, was an independent predictor of ICU mortality when controlling for co-variates (p=0.028, 95% CI 1.143-11.136).ConclusionsElevated serum alpha-KL in patients with septic shock is independently associated with higher mortality. Further studies are needed to corroborate these findings.Copyright © 2017 Elsevier Inc. All rights reserved.

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