166 Elevated heat shock protein 60 and heat shock protein 70 level measured within 24 hours of pediatric intensive care unit admission were associated with septic shock and there was a strong trend towards increased mortality. 167 , 168 Uric acid can increase cytokine production, PMN recruitment, and dendritic cell stimulation 169 and may also serve as an antioxidant. 170 The level of uric acid is reduced in the serum of neonates with sepsis as compared with control neonates. 171 In addition to facilitating leukocyte attraction, proinflammatory stimuli result in production of vasoactive substances that decrease or increase vascular tone and alter vascular permeability (see Figure 152-4 ).
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