INCREASED CIRCULATING SOLUBLE CD14 IS ASSOCIATED WITH HIGH MORTALITY IN GRAM-NEGATIVE SEPTIC SHOCK

The soluble glycoprotein sCD14 binds lipopolysaccharide, a complex tha t activates endothelial cells and that may be crucial in gram-negative sepsis. Therefore, serum sCD14 was analyzed in 54 patients with gram- negative septic shock and in 26 healthy controls. sCD14 was tested by ELISA and Western blotting. Patients had higher sCD14 concentrations t han controls (median, 3.23 vs. 2.48 mu g/mL, P = .002). Increased leve ls were associated with high mortality (median, 4.2 mu g/mL in nonsurv ivors vs. 2.8 mu g/mL in survivors, P = .001). sCD14 was found in two isoforms (49 and 55 kDa) in monocyte cultures. In sera only one of eit her form was detectable. Controls had the 49-kDa form, and patients ha d either the 49- or 55-kDa form, but patients with high levels of sCD1 4 had only the 55-kDa form. Twenty-one (53%) of 39 with the 55-kDa for m and 8 (57%) of 14 with the 49-kDa form died. Thus, the level of sCD1 4 but not its biochemical form had a prognostic value in patients with gram-negative septic shock.