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Received Jan 25, 2018; Accepted Mar 19, 2018
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1. Introduction
Sepsis, an infection complicated by acute organ dysfunction, is the major cause of death in the intensive care units, estimated to be far over 19 million cases per year worldwide [1]. Various factors, including the primary site of infection, the type of pathogen involved, the severity of the acute organ dysfunction, the primary health status, or the delay until the septic patient received the initial therapy, are decisive factors in the clinical appearance, severity, and prognosis of sepsis.
Despite improved modern critical care therapy including an early treatment initiation, support of failing organs, and treatment of the underlying infection, mortality lies between 20 and 30% in the last decade [2]. Early detection of the disease onset is therefore critical for the recognition of complex cases and high-risk patients who require immediate intensive medical care and appropriate therapy.
Various prognostic and diagnostic biomarkers for sepsis have been proposed in the literature [3]. Nevertheless, none of them show sufficient predictive power to be routinely employed in the clinical practice. Sepsis is an inflammatory response to multiple and extremely diverse factors. Therefore, identifying a single sepsis biomarker remains a challenge for critical care medicine.
Disease severity scoring systems (e.g., APACHE II, SOFA, and SAPS II) represent a quick and powerful complement to the laboratory biomarkers routinely used in the clinical setting [4, 5]. Clinical scores are a quick, noninvasive, and reliable assay used for patient stratification and outcome assessment in the ICU [6]. However, most of the scoring systems require a great amount of diverse patient data including laboratory and organ function tests, as well as a detailed patient history. In some cases, not all data is readily available at the most critical time point: the admission of a patient to the ICU with suspected septic onset.
The cholinergic system plays an important role in maintaining and modulating an adequate immune response upon an inflammatory episode. Cholinergic activity, acting extrasynaptically (nonneuronal acetylcholine), has been proposed to be a major mediator of the neuroimmune response to inflammation in a...