Increased endothelial injury in septic patients with coronary artery disease

Study objective: Recently, it was proposed that soluble intercellular adhes ion molecule (sICAM)-1 plasma levels may allow subgroup identification of p atients at risk for cardiovascular complications during sepsis. However, th e impact of preexisting coronary artery disease (CAD) on these results has not yet been tested. The aim of this study was to investigate whether plasm a levels of adhesion molecules, nitric oxide, and cytokines differ between septic patients with ol without preexisting CAD. Design: Prospective study. Setting: Surgical ICU. Patients: Forty-four septic patients, 24 of whom met the criteria of CAD. Measurement: Hemodynamic measurements were performed and blood samples were taken within 12 h after onset of sepsis (early sepsis) and again 72 h ther eafter (late sepsis). Soluble adhesion molecules and cytokines were determi ned using commercially, available enzyme-linked immunosorbent assay kits, c yclic guanosinomonophosphate (cGMP) by competitive radioimmunoassay, and ni trite/nitrate photometrically by Griess reaction. Results: In CAD patients, sICAM-1 (p < 0.02) was significantly elevated in early and late sepsis, whereas soluble endothelial-linked adhesion molecule (sE-selectin; p < 0.01) and cGMP (p < 0.03) were only increased in late se psis. Oxygen consumption did not significantly differ between groups. Oxyge n delivery and mixed venous oxygen saturation during early and late sepsis were significantly diminished and the oxygen extraction ratio significantly increased in the CAD group (p < 0.05). Conclusions: Increased endothelial injury may be indicated bq the elevated levels of sICAM-1, sE-selectin, and cGMP in septic patients with preexistin g CAD. These parameters, however, failed to serve as predictors for unknown CAD or chances for survival in early sepsis.