SOLUBLE FORM OF P-SELECTIN IN PLASMA IS ELEVATED IN ACUTE LUNG INJURY

A number of adhesion molecules on neutrophils and the pulmonary capill ary endothelium mediate the neutrophil accumulation in the lungs at th e onset of adult respiratory distress syndrome or acute lung injury (A LI). P-selectin, located on both vascular endothelial cells and platel ets, has been shown to be one of these neutrophil-endothelial cell adh esion molecules. In this study, we measured the soluble form of P-sele ctin in plasma (PPS) from 19 patients (surviving, 11; deceased, 8) wit h ALI due to various causes and assessed the clinical significance of this measurement. Twelve healthy subjects and 29 patients with other p ulmonary diseases, including idiopathic pulmonary fibrosis (IPF) (n = 8), sarcoidosis (n = 5), pneumonia (n = 8), and sepsis without ALI(n = 8) were also studied for comparison. PPS in patients with ALI (474.5 +/- 366.8 ng/ml, mean +/- SD) were significantly higher than those in control subjects (98.8 +/- 39.7, p < 0.01) and in patients with IPF(21 0.4 +/- 76.6, p < 0.05), sarcoidosis (135.2 +/- 71.5, p < 0.05) pneumo nia (225.3 +/- 81.0, p < 0.05), and sepsis without ALI (271.8 +/- 46.5 , p < 0.05). There was no significant difference in PPS levels between seven patients with and 12 patients without multiple organ failure. L ung injury scores correlated significantly with the PPS level(r = 0.60 5, p < 0.05). PPS levels of deceased patients with ALI(841.0 +/- 252.4 ) were significantly higher than those of surviving patients with Atl (208.0 +/- 109.2, p < 0.01). These findings suggest that PPS levels we re elevated in the plasma of patients with ALI, especially in those wh o subsequently died, as compared with those in patients with other pul monary disease or sepsis without ALI.