Circulating intercellular adhesion molecule-1 as an early predictor of hepatic failure in patients with septic shock.
OBJECTIVE
To investigate whether endotoxin, interleukin-6, and circulating adhesion molecules, measured sequentially in blood, can predict mortality and organ dysfunction in sepsis.


METHODS
Inception cohort study with follow-up for 28 days.


METHODS
Surgical intensive care unit at a university hospital.


METHODS
A total of 14 consecutive patients were enrolled in the study within the first 24 hrs after onset of septic shock. Seven healthy subjects were studied as controls.


METHODS
Patients were analyzed for mortality and development of organ dysfunction.


RESULTS
At the end of the 28-day follow-up period, seven of the patients were still alive (survivors) but the other seven (nonsurvivors) had died. At the time of enrollment in the study (day 0), the Acute Physiology and Chronic Health Evaluation II score was 28.4 in survivors (n = 7) and 28.7 in nonsurvivors (n = 7). In contrast, circulating intercellular adhesion molecule-1 (ICAM-1) was significantly higher in nonsurvivors than in survivors. Circulating ICAM-1 predicted mortality in patients with septic shock with a sensitivity and a specificity of 71.4% each. Endotoxin, interleukin-6, circulating L-selectin, P-selectin, E-selectin, and platelet endothelial cell adhesion molecule-1, however, did not distinguish between survivors and nonsurvivors. In addition, circulating ICAM-1 at day 0 showed a significant correlation with the highest serum bilirubin observed during the entire study period (r2 = 0.963).


CONCLUSIONS
Because only circulating ICAM-1 was higher in nonsurvivors than in survivors at day 0, circulating ICAM-1 may serve as an early prognostic marker for outcome in septic shock. In addition, measurement of circulating ICAM-1 facilitates identification of those patients with the highest risk of developing liver dysfunction.
Weigand
M A
MA
Department of Anesthesiology, University of Heidelberg, Germany.
Schmidt
H
H
Pourmahmoud
M
M
Zhao
Q
Q
Martin
E
E
Bardenheuer
H J
HJ
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D017093:Liver Failure / Q000097:blood* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012016:Reference Values; D019087:Selectins / Q000097:blood; D012772:Shock, Septic / Q000097:blood* / Q000145:classification / Q000401:mortality
D015850:Interleukin-6; D019087:Selectins; D018799:Intercellular Adhesion Molecule-1