Early elevation of plasma soluble intercellular adhesion molecule-1 in pediatric acute lung injury identifies patients at increased risk of death and prolonged mechanical ventilation.
OBJECTIVE
To determine whether soluble intercellular adhesion molecule (sICAM)-1, a biological marker of alveolar epithelial and lung endothelial injury and alveolar macrophage activation, is elevated in the plasma of pediatric patients with acute lung injury and to examine whether elevated plasma sICAM-1 levels correlate with two clinically relevant outcomes, mortality and the duration of mechanical ventilation.


METHODS
Prospective cohort study.


METHODS
Pediatric intensive care units at an urban children's hospital and a tertiary university medical center.


METHODS
Eighty-three pediatric patients with acute lung injury and five intubated controls.


METHODS
Plasma sICAM-1 levels were measured on days 1 and 2 of acute lung injury in pediatric patients and on day 1 of mechanical ventilation in control patients.


RESULTS
Plasma sICAM-1 levels were significantly higher in patients with acute lung injury compared with controls (966 +/- 830 vs. 251 +/- 168 ng/mL, p <.05). Levels of sICAM-1 were also significantly higher on days 1 and 2 of acute lung injury in nonsurvivors and in patients requiring prolonged duration of mechanical ventilation. Also, plasma sICAM-1 levels >1000 ng/mL had a high specificity for identifying nonsurvivors of acute lung injury.


CONCLUSIONS
Early elevation of sICAM-1 in the plasma of pediatric patients with acute lung injury is associated with increased risk of death or prolonged duration of mechanical ventilation.
Flori
Heidi R
HR
Department of Pediatric Critical Care, Children's Hospital and Research Center, Oakland, Oakland, CA 94609, USA. hflori@mail.cho.org
Ware
Lorraine B
LB
Glidden
David
D
Matthay
Michael A
MA
D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000401:mortality*; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood* / Q000401:mortality; D013997:Time Factors
D015415:Biomarkers; D018799:Intercellular Adhesion Molecule-1