PLASMA-LEVELS OF SOLUBLE E-SELECTIN IN PATIENTS WITH DISSEMINATED INTRAVASCULAR COAGULATION

The plasma level of soluble E-selectin (sE) reflects the activation of endothelial cells induced by cytokines such as tumor necrosis factor- alpha and interleukin-1 in vitro. These cytokines are important in the development of coagulation abnormalities in patients with sepsis. We compared the plasma levels of sE in patients with infections suspected of having disseminated intravascular coagulation (DIC) (n = 33) and i n patients with underlying disorders other than infections, including solid tumors (n = 28), obstetric disorders (n = 13), hematologic malig nancies (n = 13), and liver disease (n = 9), to clarify the involvemen t of cytokines in the development of coagulation abnormalities in pati ents with sepsis. Plasma levels of sE in patients with infection were significantly higher than in patients with the other underlying disord ers. The plasma level of sE was also significantly higher in patients with infection with DIC (114.6 +/- 77.9 ng/ml, n = 21) than in patient s with infection without DIC (54.5 +/- 53.1 ng/ml, n = 12, P < 0.02). There was no significant difference in sE level between patients with the other underlying disorders with and without DIG. The plasma level of sE was significantly correlated with the serum level of FDP(E) in p atients with infection, The plasma level of sE was significantly highe r in patients with infection with organ failure compared to patients w ithout organ failure. There was no significant difference between pati ents with the other underlying disorders with and without organ failur e. Plasma levels of tumor necrosis factor-alpha and interleukin-6 were detected in only 12.1% and 20.0% of patients with infections, respect ively. These observations strongly suggest that plasma levels of sE re flect the activation of endothelial cells induced by cytokines, which may lead to DIC and organ failure in the presence of sepsis. Furthermo re, determination of plasma level of sE may be useful for detecting th e endothelial activation induced by cytokines in the pathologic condit ions of sepsis, even when plasma levels of cytokines cannot be detecte d. (C) 1997 Wiley-Liss, Inc.