THE CIRCULATING ADHESION MOLECULES SICAM- 1 AND SE-SELECTIN IN PATIENTS WITH SEPSIS

Aim: The aim of this study was to investigate whether the plasma level s of the circulating adhesion molecules sICAM-1 and sE-selectin could serve as early predictors of developing sepsis and its severity. Metho ds: Twenty-four patients admitted to an intensive care unit with a hig h risk of developing septic complications were enrolled in this study. Patients were divided into three groups: group I,with infection witho ut systemic sepsis, n = 8; group II, surviving patients with severe se psis and multi-organ failure (MOF), n = 8; and group III, nonsurviving patients with severe sepsis and MOF, n = 8. Classification of patient s was performed according to the clinical criteria defined by the Seps is Consensus Conference in 1992. Blood samples were taken at 7 a.m. st arting from the day of admission until the 7th day after diagnosis of sepsis. Plasma levels of sICAM-1 and sE-selectin were determined in al l samples taken between the 3rd pre-septic day and the 7th day after t he diagnosis of sepsis was made. Results: In group I, both sICAM-1 (35 4.21 +/- 128.60 ng/ml, 86 samples) and sE-selectin (30.41 +/- 7.20 ng/ ml, 86 samples) levels remained within the reference range over the wh ole period of observation. The sICAM-1 levels of group II (between 550 .82 +/- 275.67 ng/ml and 445.08 +/- 243.63 ng/ml) tended to show value s above the reference range without being significant. Mean sICAM-1 le vels in group II did not differ from those of group I. From the 2nd pr e-septic day onwards the sICAM-1 levels of group III increased, but no t significantly. Significant differences in sICAM-1 levels between gro up I and group III were observed, with peaks at the samples of the 2nd pre-septic day and after the 3rd day of sepsis, respectively (P < 0.0 5). The sE-selectin levels in group II were elevated from the 3rd pre- septic day onwards, with a peak value on the 2nd day of sepsis (P < 0. 05). Afterwards, levels decreased to initial values despite ongoing se psis. Mean values of sE-selectin levels of group I and II were signifi cantly different with the onset of sepsis (P < 0.05). Plasma levels of sE-selectin in group III were significantly elevated (66.30 +/- 9.00 ng/ml on the 3rd pre-septic day), reaching their maximal values of 106 .67 +/- 21.66 ng/ml at the end of the observation period. Significant differences between sE-selectin levels of groups I and III existed fro m the 3rd pre-septic day onwards, and between group II and III on the 7th and 8th day of sepsis. Conclusion: Our results show that sICAM-1 i s a relatively non-specific indicator for sepsis. In contrast, sE-sele ctin seems to be a good and early predictor of the beginning of severe sepsis with MOF. Furthermore, sE-selectin levels seem to have a progn ostic value for the severity, possible course, and outcome of developi ng sepsis.