title: Endothelial adhesion molecules and multiple organ failure in patients with severe sepsis.
abstract: To determine if serum levels of endothelial adhesion molecules were associated with the development of multiple organ failure (MOF) and in-hospital mortality in adult patients with severe sepsis.
  
  
  
  This study was a secondary data analysis of a prospective cohort study.
  
  
  
  Patients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012.
  
  
  
  Patients with severe sepsis at the time of intensive care unit (ICU) admission were enrolled. Inclusion criteria were consistent with previously published criteria for severe sepsis or septic shock in adults. Exclusion criteria included immunosuppressive medications or conditions.
  
  
  
  None.
  
  
  
  Baseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72h of ICU admission: Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1), and Vascular Endothelial Growth Factor (VEGF). The primary and secondary outcomes were development of MOF (⩾2 organ dysfunction) and in-hospital mortality, respectively.
  
  
  
  Forty-eight patients were enrolled in this study, of which 29 (60%) developed MOF. Patients that developed MOF had higher levels of VCAM-1 (p=0.01) and ICAM-1 (p=0.01), but not VEGF (p=0.70) compared with patients without MOF (single organ failure only). The area under the curve (AUC) to predict MOF according to VCAM-1, ICAM-1 and VEGF was 0.71, 0.73, and 0.54, respectively. Only increased VCAM-1 levels were associated with in-hospital mortality (p=0.03). These associations were maintained even after adjusting for APACHE and SOFA scores using logistic regression.
  
  
  
  High levels of serum ICAM-1 was associated with the development of MOF. High levels of VCAM-1 was associated with both MOF and in-hospital mortality.
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Bravein
authors.initials: B
authors.lastname: Amalakuhan
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Habib
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Mandeep
authors.initials: M
authors.lastname: Mangat
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Reyes
authors.affiliation: Critical Care Department, Joan XXIII University Hospital and Pere Virgili Health Institute, CIBERES, Tarragona, Spain.
authors.forename: Alejandro H
authors.initials: AH
authors.lastname: Rodriguez
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Cecilia A
authors.initials: CA
authors.lastname: Hinojosa
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA.
authors.forename: Nilam J
authors.initials: NJ
authors.lastname: Soni
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Gilley
authors.affiliation: Camino Distrital Universitario Adelita de Char, Barranquilla, Colombia.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bustamante
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Levine
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA.
authors.forename: Jay I
authors.initials: JI
authors.lastname: Peters
authors.affiliation: University of Milan Bicocca, Clinica Pneumologica, Monza, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.affiliation: Servei de Pneumologia, Departament de Medicina, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Sibila
authors.affiliation: University of Dundee, Dundee, UK.
authors.forename: James D
authors.initials: JD
authors.lastname: Chalmers
authors.affiliation: Hospital Clinic, Universitat de Barcelona, Servei de Pneumologia, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Waterer
authors.affiliation: St. James's Hospital, Trinity Centre for Health Sciences, CIBERES, Dublin, Ireland.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Providence Hospital, DC, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Bordon
authors.affiliation: Unidad Cuidados Intensivos Respiratorios, Hospital Clínic Universitari, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Blanquer
authors.affiliation: Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanz
authors.affiliation: Servicio de Neumología, Instituto de investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Marcos
authors.affiliation: Critical Care Department, Hospital Universitario Vall d'Hebron, CIBERES, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
authors.affiliation: Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Solé-Violán
authors.affiliation: Division of Pulmonary Medicine, Department of Medicine, Hospital de Clinicas, Division of Pulmonology, Universidad de Buenos Aires, Buenos Aires, Argentina.
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Luna
authors.affiliation: Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Charles
authors.initials: C
authors.lastname: Feldman
authors.affiliation: Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin and SFB-TR84 "Innate Immunity of the Lung", Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Witzenrath
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Wunderink
authors.affiliation: Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.affiliation: Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
authors.forename: Tim L
authors.initials: TL
authors.lastname: Wiemken
authors.affiliation: Institute for Advanced Research and Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Dela Cruz
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; Department of Microbiology, The University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Orihuela
authors.affiliation: University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA. Electronic address: restrepom@uthscsa.edu.
authors.forename: Marcos I
authors.initials: MI
authors.lastname: Restrepo
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality; D018805:Sepsis / Q000097:blood / Q000401:mortality; D012720:Severity of Illness Index; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: C573420:ICAM1 protein, human; C467484:VEGFA protein, human; D019010:Vascular Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D018799:Intercellular Adhesion Molecule-1
keywords: Biomarkers; Intracellular Adhesion Molecule-1; Mortality; Multiple organ failure; Sepsis; Shock; Vascular Cell Adhesion Molecule-1; Vascular Endothelial Growth Factor