Increased circulating adhesion molecule concentrations in patients with the systemic inflammatory response syndrome: a prospective cohort study.
OBJECTIVE
To investigate the relationship between the soluble derivatives of endothelial adhesion molecules liberated by activated vascular endothelium and the development of the systemic inflammatory response syndrome and organ dysfunction in septic patients.


METHODS
Prospective cohort study with controls.


METHODS
University hospital intensive care unit.


METHODS
Healthy volunteers (controls, n = 85), patients with the systemic inflammatory response syndrome (n = 21), patients with systemic inflammatory response syndrome and organ dysfunction (n = 14), and miscellaneous, severely ill patients (n = 5).


METHODS
Plasma samples were collected from consecutive patients who satisfied the criteria for inclusion in the groups listed above.


RESULTS
The plasma was assayed by enzyme-linked immunosorbent assay (ELISA) for each of the three soluble adhesion molecules: sE-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1. There were low basal amounts of these adhesion molecules in the healthy volunteers, while plasma concentrations of all three adhesion molecules were increased in the sepsis groups. The median soluble E-selectin concentration was higher in those patients with organ dysfunction compared with the concentrations in patients with uncomplicated sepsis (p < .01 at first and p < .001 when comparing peak values attained). No patient survived when the amount of soluble E-selectin was > 30 units/mL.


CONCLUSIONS
Concentrations of circulating vascular endothelial adhesion molecules, especially soluble E-selectin, are increased in patients with systemic inflammatory response syndrome and these concentrations are more increased in patients with organ dysfunction. High plasma concentrations of soluble E-selectin were closely associated with multiple-organ dysfunction and death. Measurement of adhesion molecules, especially soluble E-selectin, might be used to advantage in the management of patients with sepsis.
Cowley
H C
HC
Intensive Care Unit, St. James' University Hospital, Leeds, UK.
Heney
D
D
Gearing
A J
AJ
Hemingway
I
I
Webster
N R
NR
D000328:Adult; D001424:Bacterial Infections / Q000097:blood* / Q000401:mortality; D015815:Cell Adhesion Molecules / Q000097:blood*; D015331:Cohort Studies; D019040:E-Selectin; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1; D008297:Male; D008565:Membrane Proteins / Q000097:blood*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000401:mortality; D009419:Nerve Tissue Proteins / Q000097:blood*; D011446:Prospective Studies; D050683:R-SNARE Proteins; D012720:Severity of Illness Index; D013577:Syndrome
D015815:Cell Adhesion Molecules; D019040:E-Selectin; D008565:Membrane Proteins; D009419:Nerve Tissue Proteins; D050683:R-SNARE Proteins; D018799:Intercellular Adhesion Molecule-1