Circulating endothelial mediators in human pancreatitis-associated lung injury.
OBJECTIVE
To investigate the role of endothelial cell mediators, E-selectin (ES), intercellular adhesion molecule-1 (ICAM-1), tissue factor (TF), and von Willebrand factor (vWF), in the early phase of severe acute pancreatitis (SAP) complicated with respiratory failure [pancreatitis-associated lung injury (PALI)].


METHODS
This study included 30 patients with SAP and 39 patients with PALI. Blood samples were taken from SAP and PALI patients on presenting to the hospital (day 1), and days 2, 3, 5, and 10. The relationship between blood concentrations of the studied endothelial mediators and lung function tests was analyzed.


RESULTS
PALI patients had significantly higher ES, ICAM-1, TF, and vWF blood levels than those with SAP as early as at admission and throughout the period studied. We found the highest concentration of ES on the second day, ICAM-1 and TF at admission, and vWF level on the fifth day. There were adverse correlations between ES, ICAM-1, TF, vWF concentrations, and the index of oxygenation--PaO2/FiO2 ratio (Rs=-0.385, Rs=-0.523, Rs=-0.505, Rs=-0.408, P<0.001, respectively). The most accurate prediction of PALI was provided by ICAM-1 and TF levels on the day of admission [areas under curve (AUCs): ES, 0.704; ICAM-1, 0.787; TF, 0.757; and vWF, 0.686].


CONCLUSIONS
Endothelium-related mediators ES, ICAM-1, TF, and vWF appear to participate in pancreatitis-associated lung injury. In SAP, the measurement of endothelial mediator levels (especially ICAM-1 and TF) may be used as an early prognostic indicator that would predict the development of respiratory failure and to monitor the severity of lung dysfunction.
Departments of aAnaesthesiology and Intensive Therapy bGastroenterology and Internal Medicine cBiochemical Diagnostics dHaematology, Medical University of Bialystok, Bialystok, Poland.
Andrzej
A
Siemiatkowski
Urszula
U
Wereszczynska-Siemiatkowska
Barbara
B
Mroczko
Marzenna
M
Galar
Tomasz
T
Maziewski
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D019040:E-Selectin / Q000097:blood*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010195:Pancreatitis / Q000097:blood* / Q000150:complications; D010313:Partial Pressure; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D013925:Thromboplastin / Q000378:metabolism*; D013997:Time Factors; D055815:Young Adult; D014841:von Willebrand Factor / Q000378:metabolism*
D019040:E-Selectin; D014841:von Willebrand Factor; D018799:Intercellular Adhesion Molecule-1; D013925:Thromboplastin; D010100:Oxygen