Circulating intercellular adhesion molecule-1 as an early predictor of hepatic failure in patients with septic shock

Objective: To investigate whether endotoxin, interleukin-6, and circulating adhesion molecules, measured sequentially in blood, can predict mortality and organ dysfunction in sepsis. Design: Inception cohort study with follow-up for 28 days. Setting: Surgical intensive care unit at a university hospital. Patients: A total of 14 consecutive patients were enrolled in the study wit hin the first 24 hrs after onset of septic shock. Seven healthy subjects we re studied as controls. Interventions: Patients were analyzed for mortality and development of orga n dysfunction. Measurements and Main Results: At the end of the 28-day follow-up period, s even of the patients were still alive (survivors) but the other seven (nons urvivors) had died. At the time of enrollment in the study (day 0), the Acu te Physiology and Chronic Health Evaluation II score was 28.4 in survivors (n = 7) and 28.7 in nonsurvivors (n = 7). In contrast, circulating intercel lular adhesion molecule-1 (ICAM-1) was significantly higher in non-survivor s than in survivors. Circulating ICAM-1 predicted mortality in patients wit h septic shock with a sensitivity and a specificity of 71.4% each. Endotoxi n, interleukin-g, circulating L-selectin, P-selectin, E-selectin, and plate let endothelial cell adhesion molecule-1, however, did not distinguish betw een survivors and nonsurvivors. In addition, circulating ICAM-1 at day 0 sh owed a significant correlation with the highest serum bilirubin observed du ring the entire study period (r(2) = 0.963). Conclusions: Because only circulating ICAM-1 was higher in nonsurvivors tha n in survivors at day 0, circulating ICAM-1 may serve as an early prognosti c marker for outcome in septic shock. In addition, measurement of circulati ng ICAM-1 facilitates identification of those patients with the highest ris k of developing liver dysfunction.