Endothelial-derived selectins in the development of organ dysfunction in acute pancreatitis.
OBJECTIVE
The development of organ dysfunction is the principal determinant of outcome in acute pancreatitis and is mediated through a systemic inflammatory response characterized by leukocyte and endothelial cell activation. Up-regulation of the endothelial cell adhesion molecules, E-selectin and P-selectin, is important for endothelial/leukocyte interactions. Levels of serum-soluble E-selectin and P-selectin have been suggested as markers of endothelial activation. This study examines the kinetics of serum-soluble selectins in patients with acute pancreatitis complicated by organ dysfunction.


METHODS
Prospective observational study.


METHODS
University teaching hospital with a specialist hepato-pancreatico-biliary service.


METHODS
Eighteen patients with acute pancreatitis were studied, nine of whom had organ dysfunction.


RESULTS
Serial venous blood samples were collected on the first 3 days after admission for measurement of soluble E-selectin and P-selectin by enzyme-linked immunosorbent assay. In all patients, soluble P-selectin concentrations decreased significantly during the study period. Nonsurvivors had significantly higher levels of soluble P-selectin than survivors. In contrast, soluble E-selectin increased significantly during the study period in patients with organ dysfunction, whereas it remained constant in patients without evidence of organ dysfunction.


CONCLUSIONS
These results suggest a role for endothelial-derived selectins in the development of organ dysfunction in patients with acute pancreatitis. The observed temporal differences in serum selectin concentrations is in keeping with in vitro observations of endothelial selectin expression.
Powell
J J
JJ
University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom.
Siriwardena
A K
AK
Fearon
K C
KC
Ross
J A
JA
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D019040:E-Selectin / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015600:Glasgow Coma Scale; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000276:immunology / Q000378:metabolism* / Q000401:mortality; D019007:P-Selectin / Q000097:blood*; D010195:Pancreatitis / Q000150:complications* / Q000276:immunology / Q000378:metabolism* / Q000401:mortality; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D019040:E-Selectin; D019007:P-Selectin