Soluble intercellular adhesion molecule-1 and clinical outcomes in patients with acute lung injury.
OBJECTIVE
To determine if levels of soluble intercellular adhesion molecule-1 (sICAM-1), a marker of alveolar epithelial and endothelial injury, differ in patients with hydrostatic pulmonary edema and acute lung injury (ALI) and are associated with clinical outcomes in patients with ALI.


METHODS
Measurement of sICAM-1 levels in (1) plasma and edema fluid from 67 patients with either hydrostatic pulmonary edema or ALI enrolled in an observational, prospective single center study, and (2) in plasma from 778 patients with ALI enrolled in a large multi-center randomized controlled trial of ventilator strategy.


RESULTS
In the single-center study, levels of sICAM-1 were significantly higher in both edema fluid and plasma (median 938 and 545 ng/ml, respectively) from ALI patients compared to hydrostatic edema patients (median 384 and 177 ng/ml, P < 0.03 for both comparisons). In the multi-center study, higher plasma sICAM-1 levels were associated with poor clinical outcomes in both unadjusted and multivariable models. Subjects with ALI whose plasma sICAM-1 levels increased over the first 3 days of the study had a higher risk of death, after adjusting for other important predictors of outcome (odds ratio 1.48; 95% CI 1.03-2.12, P = 0.03).


CONCLUSIONS
Both plasma and edema fluid levels of sICAM-1 are higher in patients with ALI than in patients with hydrostatic pulmonary edema. Higher plasma sICAM-1 levels and increasing sICAM-1 levels over time are associated with poor clinical outcomes in ALI. Measurement of sICAM-1 levels may be useful for identifying patients at highest risk of poor outcomes from ALI.
Calfee
Carolyn S
CS
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA, 94143-0111, USA. carolyn.calfee@ucsf.edu
Eisner
Mark D
MD
Parsons
Polly E
PE
Thompson
B Taylor
BT
Conner
Edward R
ER
Matthay
Michael A
MA
Ware
Lorraine B
LB
D055371:Acute Lung Injury / Q000378:metabolism* / Q000628:therapy*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D006874:Hydrostatic Pressure; D011654:Pulmonary Edema / Q000097:blood* / Q000503:physiopathology*; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000378:metabolism / Q000503:physiopathology