title: Serum adhesion molecules as predictors of bacteremia in adult severe sepsis patients at the emergency department.
abstract: BACKGROUND
  Bacteremia is a severe bacterial infection with significant mortality. Clinical parameters that reliably predict it are less elucidated. We assessed the potential of serum adhesion molecules for predicting bacteremia and compare it with current available infection biomarkers to determine a more timely predictor of adult severe sepsis patients on admission to the emergency department (ED).
  
  
  METHODS
  Sixty-seven consecutive non-traumatic, non-surgical adult patients with severe sepsis admitted to the ED were evaluated. Serum samples were collected and assessed while serum adhesion molecules were analyzed.
  
  
  RESULTS
  Thirty-one (46.2%) study patients had bacteremia. There were significant differences in both sICAM-1 and sE-selectin on admission between bacteremic and non-bacteremic patients. By stepwise logistic regression model, only sE-selectin was independently associated with bacteremia and any 1 ng/ml increase in level increased bacteremia rate by 0.8%. The cut-off value of sE-selectin level for predicting bacteremia was 117 ng/ml (84% sensitivity and 69% specificity).
  
  
  CONCLUSIONS
  Although serum cell adhesion markers are not specific for predicting bacteremia in septic patients, higher mean serum cell adhesion molecules levels on admission may imply both more severe infection and presence of bacteremia. Assay of serum adhesion molecules may be added as an infectious marker among the panel of bacteremic parameters in clinical practice, especially since early diagnosis and prompt antimicrobial therapy are essentially for survival.
authors: Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors: Chia-Te
authors: CT
authors: Kung
authors: Sheng-Yuan
authors: SY
authors: Hsiao
authors: Chih-Min
authors: CM
authors: Su
authors: Tsung-Cheng
authors: TC
authors: Tsai
authors: Hsien-Hung
authors: HH
authors: Cheng
authors: Nai-Wen
authors: NW
authors: Tsai
authors: Wen-Neng
authors: WN
authors: Chang
authors: Chi-Ren
authors: CR
authors: Huang
authors: Hung-Chen
authors: HC
authors: Wang
authors: Wei-Che
authors: WC
authors: Lin
authors: Yu-Jun
authors: YJ
authors: Lin
authors: Ben-Chung
authors: BC
authors: Cheng
authors: Yu-Jih
authors: YJ
authors: Su
authors: Cheng-Hsien
authors: CH
authors: Lu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000097:blood* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D019040:E-Selectin / Q000097:blood*; D004636:Emergency Service, Hospital; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D016019:Survival Analysis; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D015415:Biomarkers; D019040:E-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1