Intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 are increased in the plasma of children with sepsis-induced multiple organ failure

Objectives: To determine concentrations of circulating adhesion molecules e ndothelial (E)-selectin, intercellular adhesion molecule (ICAM)-1, and vasc ular cell adhesion molecule (VCAM)-1 in children with sepsis-induced multip le organ failure (MOF), and to determine associations among increased conce ntrations of these circulating adhesion molecules and important outcome mea sures. Design: Prospective study, Setting: University pediatric intensive care unit, Patients: A total of 77 consecutive children with sepsis and 14 acutely ill children without sepsis, Interventions: Plasma E-selectin, ICAM-1, and VCAM-1 concentrations and org an failure index (indicating number of failed organ systems) were determine d in 77 children on days 1 and 3 of sepsis, and in 14 control children on p ediatric intensive care unit day 1, Multivariate logistic regression analys is was used to determine associations between adhesion molecule concentrati ons and clinically relevant outcome measures. Measurements and Results: Plasma concentrations of E-selectin, ICAM-1, and VCAM-1 were increased in children with sepsis vs, control on day 1 (p < .05 ), Plasma VCAM-1 (but not ICAM-1 or E-selectin) was increased in children w ith more than three organ failures vs, children with less than three organ failures (p < .05), Plasma lGAM-i and VCAM-1 (but not E-selectin) concentra tions independently predicted number of organs failed and development of mo re than three organ failures, Plasma ICAM-1 and VCAM-1 also predicted morta lity and development of sequential (pulmonary/hepatic/renal) MOF (p < .05), Conclusions: The pronounced and persistent increase in plasma VCAM-1 and IC AM-1 that occurs in children with sepsis and persistent MOF may indicate a phenotypic change in endothelium toward a more proinflammatory state, Alter natively, the source for these adhesion molecules may he activated leukocyt es and other cell types, Future studies are required to determine the role of ICAM-1 and VCAM-1 in the pathogenesis of sepsis-induced MOF.