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Hypoxia-inducible factor-1 (HIF1) controls the expression of genes involved in the cellular response to hypoxia. No information is available on its expression in critically ill patients. Thus, we designed the first clinical study in order to evaluate the role of  HIF1α  as a prognosis marker in patients suffering from shock.    Methods  Fifty consecutive adult patients with shock and 11 healthy volunteers were prospectively enrolled in the study. RNA was extracted from whole blood samples and expression of  HIF1α  was assessed over the first four hours of shock. The primary objective was to assess  HIF1α  as a prognostic marker in shock. Secondary objectives were to evaluate the role of  HIF1α  as a diagnostic and follow-up marker. Patient survival was evaluated at day 28.    Results  The causes of shock were sepsis (78%), hemorrhage (18%), and cardiac dysfunction (4%).  HIF1α  expression was significantly higher in the shock patients than in the healthy volunteers (121 (range: 72-168)  versus  48 (range: 38-54) normalized copies,  P  <0.01), whatever the measured isoforms. It was similar in non-survivors and survivors (108 (range 84-183)  versus  121(range 72-185) normalized copies,  P  = 0.92), and did not significantly change within the study period.    Conclusions  The present study is the first to demonstrate an increased expression of  HIF1α  in patients with shock. Further studies are needed to clarify the potential association with outcome. Our findings reinforce the value of monitoring plasma lactate levels to guide the treatment of shock.

Hypoxia-inducible factor (HIF1α) gene expression in human shock states