Evaluation of the effect of melatonin supplement on sepsis associated damage indicators in intensive care unit

 sepsis is a severe inflammatory response mediated by infection witch is characterized by oxidative stress, cytokines release and impairment of mitochondrial function. Sepsis associated encephalopathy is a transient and reversible impairment of brain function witch is affect approximately 30 percent of septic patients. Melatonin has an important physiologic role in sleep and circadian rhythm regulation, immunity system regulation, antioxidant and mitochondria protective functions, reproduction control and mood regulation. We done a double blind randomized clinical trial in order to evaluate effect of melatonin supplement on damage indicators in 28 patients with sepsis admitted to general intensive care unit. patients in melatonin receiving group, as soon as possible after the confirmation of the diagnosis of sepsis, was taken melatonin tablets with the dose of 51 milligrams 2 hours after the administration of night dietary gavage each night for the duration of 5 nights in addition to antibiotic regimen by the nurse. Patients in control group received antibiotic regimen without melatonin. Standard antibiotic protocol considered for the patients included in the study is similar and contains imipenem or meropenem plus vancomycin plus amikacin. Blood sample obtain from all patients included in the study in order to measure laboratory indicators associate with sepsis such as serum lactate, serum procalcitonin, CRP and also serum levels of S100B and NSE one time on arrival to the study and other time after receipt of the last dose of melatonin. Moreover, SOFA score and TISS 28 score were evaluated before and after intervention with melatonin. in this study the mean ± S.D. of SOFA score in melatonin receiving group after the end of intervention was significantly lower than the control group (5.71 ± 3.56 vs 7.14 ± 3.70, P=0.011). Other clinically and laboratory findings did not show any significant difference between two groups after the end of study. according to investigational aspect of melatonin administration for improvement of sepsis associated indicators and lack of comprehensive clinical guideline in order to determine optimal dose, route of administration and appropriate duration of treatment with melatonin in this indication, further investigations is necessary in this field to exactly determine the above mentioned points. Altogether it is necessary to note that with consideration of the results of this study and few other studies in this field with small sample sizes, decision about melatonin supplement efficacy or not as additive therapy in patients with sepsis, require performance of more clinical trials with greater study populations.