Plasma soluble e-selectin in necrotising enterocolitis.
OBJECTIVE
E-selectin is an important mediator of leukocyte-endothelial adhesion. It is expressed on activated endothelium, and shed into the circulation in its soluble form. In babies with necrotising enterocolitis (NEC), increased intestinal expression of E-selectin has been associated with multiple organ failure and an adverse outcome. The aim of this study was to determine whether increased circulating soluble E-selectin (sE-selectin) was associated with a worse prognosis.


METHODS
With ethical approval, plasma samples from 20 infants with Bell stage II and III NEC were analysed. Both pre- and postoperative samples were available in 6 infants. The severity of illness was assessed using a sequential organ failure assessment score (SOFA) specifically designed for use in NEC. Plasma concentration of sE-selectin was determined by ELISA. Data, which were not normally distributed, were compared by Spearman's rank correlation coefficient and Wilcoxon signed rank test.


RESULTS
Plasma sE-selectin was strongly negatively correlated with corrected gestational age at the time of sampling (r = - 0.425, p = 0.006). There was no association between plasma sE-selectin and outcome (death or survival to discharge), severity of intestinal disease (focal, multifocal or pan-intestinal), or SOFA score. Surgery for suspected perforation, however, caused a significant elevation in sE-selectin levels (p = 0.031).


CONCLUSIONS
Plasma sE-selectin, a described marker of endothelial activation, is increased following surgery for NEC. However, prematurity appears to be the cause of an increase in sE-selectin level, confounding the potential use of sE-selectin levels as a predictor of severity of illness in NEC.
Khoo
A K
AK
Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK.
Hall
N J
NJ
Alexander
N
N
Evennett
N J
NJ
Pierro
A
A
Eaton
S
S
D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D019040:E-Selectin / Q000097:blood*; D020345:Enterocolitis, Necrotizing / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007416:Intestinal Perforation / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D015415:Biomarkers; D019040:E-Selectin