PROGNOSTIC VALUE OF MIP-1-ALPHA, TGF-BETA(2), SELAM-1, AND SVCAM-1 INPATIENTS WITH GRAM-POSITIVE SEPSIS

The aim of the present study was to evaluate the potential prognostic value of MIP-1 alpha, TGF-beta(2) sELAM-1, and sVCAM-1 in patients wit h gram-positive sepsis. Twenty-eight patients with gram-positive sepsi s were compared to 11 patients with gram-negative sepsis and 15 health y volunteers. Sepsis was defined by the criteria of Bone ct al. (Crit. Care Med. 21, 5447-5463, 1993) and by isolation of at least two posit ive blood cultures with gram-positive/gram-negative bacteria. Plasma s amples for determination of the immunological parameters were collecte d daily. Analysis of cytokines and adhesion molecules was performed on days 0 (day of sepsis criteria fulfillment), 4, and 7 (or 1 day befor e death). In the gram-positive group 10 of 28 patients died; in the gr am-negative group 4 of 11 died. Only sELAM-1 plasma concentrations wer e found to be a useful early parameter in predicting patients' outcome in gram-positive sepsis. sELAM-1 concentrations at the onset of the s tudy (day 0) were significantly higher in the nonsurviving patients th an those in the survivors. MIP-1 alpha levels were significantly highe r only on days 4 and 7. With regard to the measured plasma concentrati ons we believe that MIP-1 alpha is not a useful parameter for predicti ng patients' prognosis. The increase of sVCAM-1 might play a role in t he pathogenesis of gram-positive sepsis; however, it could not be reli ed upon as an early prognostic parameter. The potential role of TGF-be ta(2) in the development of gram-positive sepsis could not be evaluate d in the present study, whereas routine measurements of TGF-beta(2) of fered no additional prognostic information, (C) 1998 Academic Press.