INCREASED CIRCULATING ADHESION MOLECULE CONCENTRATIONS IN PATIENTS WITH THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME - A PROSPECTIVE COHORT STUDY

Objective: To investigate the relationship between the soluble derivatives of endothelial adhesion molecules liberated by activated vascular endothelium and the development of the systemic inflammatory response syndrome and organ dysfunction in septic patients. Design: Prospective cohort study with controls. Setting: University hospital intensive care unit. Patients: Healthy volunteers (controls, n = 85), patients with the systemic inflammatory response syndrome (n = 21), patients with systemic inflammatory response syndrome and organ dysfunction (n = 14), and miscellaneous, severely ill patients (n = 5). Interventions: Plasma samples were collected from consecutive patients who satisfied the criteria for inclusion in the groups listed above. Measurements and Main Results: The plasma was assayed by enzyme-linked immunosorbent assay (ELISA) for each of the three soluble adhesion molecules: sE-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1. There were low basal amounts of these adhesion molecules in the healthy volunteers, while plasma concentrations of all three adhesion molecules were increased in the sepsis groups. The median soluble E-selectin concentration was higher in those patients with organ dysfunction compared with the concentrations in patients with uncomplicated sepsis <.01 at first and p <.001 when comparing peak values attained). No patient survived when the amount of soluble E-selectin was >30 units/ mL. Conclusions: Concentrations of circulating vascular endothelial adhesion molecules, especially soluble E-selectin, are increased in patients with systemic inflammatory response syndrome and these concentrations are more increased in patients with organ dysfunction. High plasma concentrations of soluble E-selectin were closely associated with multiple-organ dysfunction and death. Measurement of adhesion molecules, especially soluble E-selectin, might be used to advantage in the management of patients with sepsis.