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 derivat ives 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: Prospectiv e cohort study with controls. Setting: University hospital intensive c are unit. Patients: Healthy volunteers (controls, n = 85), patients wi th 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: Pl asma samples were collected from consecutive patients who satisfied th e criteria for inclusion in the groups listed above. Measurements and Main Results: The plasma was assayed by enzyme-linked immunosorbent as say (ELISA) for each of the three soluble adhesion molecules: sE-selec tin, vascular cell adhesion molecule-1, and intercellular adhesion mol ecule-1. There were low basal amounts of these adhesion molecules in t he healthy volunteers, while plasma concentrations of all three adhesi on molecules were increased in the sepsis groups. The median soluble E -selectin concentration was higher in those patients with organ dysfun ction 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 uni ts/ mL. Conclusions: Concentrations of circulating vascular endothelia l adhesion molecules, especially soluble E-selectin, are increased in patients with systemic inflammatory response syndrome and these concen trations are more increased in patients with organ dysfunction. High p lasma concentrations of soluble E-selectin were closely associated wit h multiple-organ dysfunction and death. Measurement of adhesion molecu les, especially soluble E-selectin, might be used to advantage in the management of patients with sepsis.