Endothelial adhesion molecules and multiple organ failure in patients with severe sepsis |
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| Affiliation: | 1. University of Texas Health Science Center San Antonio, San Antonio, TX, USA;2. South Texas Veterans Health Care System, USA;3. Camino Distrital Universitario Adelita de Char, Barranquilla, Colombia;4. University of Milan Bicocca, Clinica Pneumologica, Monza, Italy;5. Servei de Pneumologia, Departament de Medicina, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain;6. Critical Care Department, Joan XXIII University Hospital and Pere Virgili Health Institute, CIBERES, Tarragona, Spain;7. University of Dundee, Dundee, UK;8. Hospital Clinic, Universitat de Barcelona, Servei de Pneumologia, Barcelona, Spain;9. School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia;10. St. James’s Hospital, Trinity Centre for Health Sciences, CIBERES, Dublin, Ireland;11. Department of Medicine, Section of Infectious Diseases, Providence Hospital, DC, USA;12. Unidad Cuidados Intensivos Respiratorios, Hospital Clínic Universitari, Valencia, Spain;13. Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain;14. 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;15. Critical Care Department, Hospital Universitario Vall d’Hebron, CIBERES, Barcelona, Spain;p. Division of Infectious Diseases, University of Louisville, Louisville, KY, USA;q. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, Spain;r. Division of Pulmonary Medicine, Department of Medicine, Hospital de Clinicas, Division of Pulmonology, Universidad de Buenos Aires, Buenos Aires, Argentina;s. Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa;t. Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;u. Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin and SFB-TR84 “Innate Immunity of the Lung”, Berlin, Germany;v. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;w. Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland;x. Institute for Advanced Research and Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan;y. Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA;z. Department of Microbiology, The University of Alabama at Birmingham, Birmingham, AL, USA;1. Division of Cardiology, Department of Medicine, Columbia University Medical Center, Columbia University, New York City, NY;2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN;3. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN;1. Department of Intensive Care Medicine, Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Medical Center, Nijmegen, the Netherlands;2. Department of Pharmacology and Toxicology, Nijmegen Centre for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands;1. Department of Clinical Pharmacology, College of Pharmacy, Dalian Medical University, 9 west section, Lvshun South Road, Lvshunkou District, Dalian 116044, Liaoning Province, China;2. Department of Biotechnology, Dalian Institute of Chemical Physics, Chinese Academy of Sciences, 457 Zhongshan Road, Shahekou District, Dalian 116023, Liaoning Province, China |
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| Abstract: | ObjectiveTo 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.DesignThis study was a secondary data analysis of a prospective cohort study.SettingPatients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012.PatientsPatients 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.InterventionsNone.MeasurementsBaseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72 h 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.Main resultsForty-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.ConclusionsHigh 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. |
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| Keywords: | Biomarkers Sepsis Shock Mortality Multiple organ failure Intracellular Adhesion Molecule-1 Vascular Cell Adhesion Molecule-1 Vascular Endothelial Growth Factor |
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