Bravein Amalakuhan1, Sheila A Habib1, Mandeep Mangat1, Luis F Reyes2, Alejandro H Rodriguez3, Cecilia A Hinojosa1, Nilam J Soni2, Ryan P Gilley1, Carlos A Bustamante4, Antonio Anzueto2, Stephanie M Levine2, Jay I Peters2, Stefano Aliberti5, Oriol Sibila6, James D Chalmers7, Antoni Torres8, Grant W Waterer9, Ignacio Martin-Loeches10, Jose Bordon11, Jose Blanquer12, Francisco Sanz13, Pedro J Marcos14, Jordi Rello15, Julio Ramirez16, Jordi Solé-Violán17, Carlos M Luna18, Charles Feldman19, Martin Witzenrath20, Richard G Wunderink21, Daiana Stolz22, Tim L Wiemken16, Yuichiro Shindo23, Charles S Dela Cruz24, Carlos J Orihuela25, Marcos I Restrepo26. 1. University of Texas Health Science Center San Antonio, San Antonio, TX, USA. 2. University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA. 3. Critical Care Department, Joan XXIII University Hospital and Pere Virgili Health Institute, CIBERES, Tarragona, Spain. 4. Camino Distrital Universitario Adelita de Char, Barranquilla, Colombia. 5. University of Milan Bicocca, Clinica Pneumologica, Monza, Italy. 6. Servei de Pneumologia, Departament de Medicina, Hospital Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 7. University of Dundee, Dundee, UK. 8. Hospital Clinic, Universitat de Barcelona, Servei de Pneumologia, Barcelona, Spain. 9. School of Medicine and Pharmacology, Royal Perth Hospital Unit, University of Western Australia, Perth, Australia. 10. St. James's Hospital, Trinity Centre for Health Sciences, CIBERES, Dublin, Ireland. 11. Department of Medicine, Section of Infectious Diseases, Providence Hospital, DC, USA. 12. Unidad Cuidados Intensivos Respiratorios, Hospital Clínic Universitari, Valencia, Spain. 13. Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain. 14. Servicio de Neumología, Instituto de investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain. 15. Critical Care Department, Hospital Universitario Vall d'Hebron, CIBERES, Barcelona, Spain. 16. Division of Infectious Diseases, University of Louisville, Louisville, KY, USA. 17. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, Spain. 18. Division of Pulmonary Medicine, Department of Medicine, Hospital de Clinicas, Division of Pulmonology, Universidad de Buenos Aires, Buenos Aires, Argentina. 19. Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa; Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 20. Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin and SFB-TR84 "Innate Immunity of the Lung", Berlin, Germany. 21. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. 22. Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland. 23. Institute for Advanced Research and Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. 24. Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT, USA. 25. University of Texas Health Science Center San Antonio, San Antonio, TX, USA; Department of Microbiology, The University of Alabama at Birmingham, Birmingham, AL, USA. 26. University of Texas Health Science Center San Antonio, San Antonio, TX, USA; South Texas Veterans Health Care System, USA. Electronic address: restrepom@uthscsa.edu.
Abstract
OBJECTIVE: To determine if serum levels of endothelial adhesion molecules were associated with the development of multiple organ failure (MOF) and in-hospital mortality in adult patients with severe sepsis. DESIGN: This study was a secondary data analysis of a prospective cohort study. SETTING: Patients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012. PATIENTS: Patients with severe sepsis at the time of intensive care unit (ICU) admission were enrolled. Inclusion criteria were consistent with previously published criteria for severe sepsis or septic shock in adults. Exclusion criteria included immunosuppressive medications or conditions. INTERVENTIONS: None. MEASUREMENTS: Baseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72h of ICU admission: Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1), and Vascular Endothelial Growth Factor (VEGF). The primary and secondary outcomes were development of MOF (⩾2 organ dysfunction) and in-hospital mortality, respectively. MAIN RESULTS: Forty-eight patients were enrolled in this study, of which 29 (60%) developed MOF. Patients that developed MOF had higher levels of VCAM-1 (p=0.01) and ICAM-1 (p=0.01), but not VEGF (p=0.70) compared with patients without MOF (single organ failure only). The area under the curve (AUC) to predict MOF according to VCAM-1, ICAM-1 and VEGF was 0.71, 0.73, and 0.54, respectively. Only increased VCAM-1 levels were associated with in-hospital mortality (p=0.03). These associations were maintained even after adjusting for APACHE and SOFA scores using logistic regression. CONCLUSIONS: High levels of serum ICAM-1 was associated with the development of MOF. High levels of VCAM-1 was associated with both MOF and in-hospital mortality. Published by Elsevier Ltd.
OBJECTIVE: To determine if serum levels of endothelial adhesion molecules were associated with the development of multiple organ failure (MOF) and in-hospital mortality in adult patients with severe sepsis. DESIGN: This study was a secondary data analysis of a prospective cohort study. SETTING:Patients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012. PATIENTS: Patients with severe sepsis at the time of intensive care unit (ICU) admission were enrolled. Inclusion criteria were consistent with previously published criteria for severe sepsis or septic shock in adults. Exclusion criteria included immunosuppressive medications or conditions. INTERVENTIONS: None. MEASUREMENTS: Baseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72h of ICU admission: Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1), and Vascular Endothelial Growth Factor (VEGF). The primary and secondary outcomes were development of MOF (⩾2 organ dysfunction) and in-hospital mortality, respectively. MAIN RESULTS: Forty-eight patients were enrolled in this study, of which 29 (60%) developed MOF. Patients that developed MOF had higher levels of VCAM-1 (p=0.01) and ICAM-1 (p=0.01), but not VEGF (p=0.70) compared with patients without MOF (single organ failure only). The area under the curve (AUC) to predict MOF according to VCAM-1, ICAM-1 and VEGF was 0.71, 0.73, and 0.54, respectively. Only increased VCAM-1 levels were associated with in-hospital mortality (p=0.03). These associations were maintained even after adjusting for APACHE and SOFA scores using logistic regression. CONCLUSIONS: High levels of serum ICAM-1 was associated with the development of MOF. High levels of VCAM-1 was associated with both MOF and in-hospital mortality. Published by Elsevier Ltd.
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