Elevated plasma and lung endothelial selectin levels in patients with acute respiratory distress syndrome and a history of chronic alcohol abuse.
OBJECTIVE
Activation of endothelial cells is a critical step in the pathogenesis of acute respiratory distress syndrome (ARDS). Soluble endothelial selectin (sE-selectin), an endothelial cell-specific molecule that mediates leukocyte-endothelial cell adhesion has never been measured in the bronchoalveolar lavage fluid of critically ill patients. Based on the effects of alcohol on endothelial cell and alveolar-capillary barrier function, we hypothesized that chronic alcohol exposure may be associated with increased sE-selectin in ARDS patients.


METHODS
Prospective observational cohort study.


METHODS
Medical and surgical intensive care units; an inpatient alcohol detoxification unit within university-affiliated hospitals.


METHODS
A total of 20 ARDS patients (50% with chronic alcohol abuse); seven individuals with a history of chronic alcohol abuse.


METHODS
Patients underwent bronchoalveolar lavage within 72 hrs of ARDS diagnosis. Individuals with a history of chronic alcohol abuse underwent bronchoalveolar lavage within 7 days of their last alcoholic beverage. A history of chronic alcohol abuse was determined by a Short Michigan Alcohol Screening Test score of > or =3 or a history of an alcohol-related diagnosis. sE-selectin was measured in plasma and bronchoalveolar lavage.


RESULTS
Neither severity of illness nor at-risk diagnosis differed by alcohol history. sE-selectin levels in the plasma of ARDS patients who abused alcohol chronically were significantly elevated compared with nonalcoholic ARDS patients (181 ng/mL [56-328] vs. 32 ng/mL [14-55], p <.01). The bronchoalveolar lavage sE-selectin levels from the patients with ARDS and alcohol abuse were also significantly elevated compared with nonalcoholic ARDS patients (1.51 ng/mL [1.09-3.11] vs. 0.69 ng/mL [0.33-0.94], p <.002) and were higher than those measured in individuals with a history of chronic alcohol abuse but without ARDS (0.46 ng/mL [0.12-2.75], p =.15).


CONCLUSIONS
ARDS patients who chronically abuse alcohol have elevated concentrations of sE-selectin in both the plasma and epithelial lining fluid consistent with altered endothelial cell and alveolar-capillary barrier function.
Burnham
Ellen L
EL
Department of Medicine, Division of Pulmonary and Critical Care, Emory University School of Medicine, Atlanta, GA, USA.
Moss
Marc
M
Harris
Frank
F
Brown
Lou Ann S
LA
D000437:Alcoholism / Q000150:complications*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D016022:Case-Control Studies; D019040:E-Selectin / Q000378:metabolism*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000378:metabolism* / Q000401:mortality; D018709:Statistics, Nonparametric
D019040:E-Selectin