title: Influence of diabetes on endothelial cell response during sepsis.
abstract: OBJECTIVE
  Several endothelial pathways of cell adhesion, coagulation and vascular endothelial growth factor (VEGF) signalling are activated during sepsis. The objective of this analysis was to investigate the influence of diabetes on biomarkers of endothelial cell activation in sepsis.
  
  
  METHODS
  This was a prospective observational cohort study of a convenience sample of adult patients (age ≥ 18 years) for whom infection was clinically suspected and who presented to an urban tertiary care emergency department between February 2005 and November 2008. We investigated the association of diabetes and sepsis with various endothelial activation biomarkers of cell adhesion (E-selectin, vascular cell adhesion molecule 1 [VCAM-1] and intercellular adhesion molecule 1 [ICAM-1]), coagulation (plasminogen activator inhibitor 1 [PAI-1]) and VEGF signalling (soluble fms-like tyrosine kinase-1 [sFLT-1]).
  
  
  RESULTS
  A total of 207 patients (34% with sepsis, 32% with severe sepsis and 34% with septic shock) were studied, including 63 (30%) with diabetes. Compared with patients without diabetes, patients with diabetes had significantly increased E-selectin and sFLT-1 levels overall; this was most pronounced during septic shock in the stratified analysis. Multivariate models including age, sex, sepsis severity and other variables as potential covariates confirmed the association of diabetes with elevated circulating plasma levels of E-selectin (standardised β 0.24, p < 0.001) and sFLT-1 (standardised β 0.19, p < 0.01), but there was no significant association with VCAM-1, ICAM-1 or PAI-1.
  
  
  CONCLUSIONS
  During septic shock, patients with diabetes had higher levels of circulating biomarkers of endothelial cell adhesion (E-selectin) and VEGF signalling (sFLT-1). Future studies should address whether enhanced activation of the endothelium places patients with diabetes at increased risk for the development of sepsis and worsening morbidity and mortality.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, CC2-W, Boston, MA 02215, USA. schuetzph@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Schuetz
authors.forename: K
authors.initials: K
authors.lastname: Yano
authors.forename: M
authors.initials: M
authors.lastname: Sorasaki
authors.forename: L
authors.initials: L
authors.lastname: Ngo
authors.forename: M
authors.initials: M
authors.lastname: St Hilaire
authors.forename: J M
authors.initials: JM
authors.lastname: Lucas
authors.forename: W
authors.initials: W
authors.lastname: Aird
authors.forename: N I
authors.initials: NI
authors.lastname: Shapiro
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000378:metabolism* / Q000503:physiopathology; D019040:E-Selectin / Q000378:metabolism; D004730:Endothelium, Vascular / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism; D011446:Prospective Studies; D018805:Sepsis / Q000378:metabolism*; D019010:Vascular Cell Adhesion Molecule-1 / Q000378:metabolism; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D040281:Vascular Endothelial Growth Factor Receptor-1 / Q000378:metabolism
chemical_list: D019040:E-Selectin; D017395:Plasminogen Activator Inhibitor 1; D019010:Vascular Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D018799:Intercellular Adhesion Molecule-1; D040281:Vascular Endothelial Growth Factor Receptor-1