Endothelial adhesion molecules and multiple organ failure in patients with severe sepsis
Por:
Amalakuhan, B, Habib, SA, Mangat, M, Reyes, LF, Rodriguez, AH, Hinojosa, CA, Soni, NJ, Gilley, RP, Bustamante, CA, Anzueto, A, Levine, SM, Peters, JI, Aliberti, S, Sibila, O, Chalmers, JD, Torres, A, Waterer, GW, Martin-Loeches, I, Bordon, J, Blanquer, J, Sanz, F, Marcos, PJ, Rello, J, Ramirez, J, Sole-Violan, J, Luna, CM, Feldman, C, Witzenrath, M, Wunderink, RG, Stolz, D, Wiemken, TL, Shindo, Y, Dela Cruz, CS, Orihuela, CJ, Restrepo, MI
Publicada:
1 dic 2016
Resumen:
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 72 h 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 ( 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.
Filiaciones:
Amalakuhan, B:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Habib, SA:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Mangat, M:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Reyes, LF:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Rodriguez, AH:
Joan XXIII Univ Hosp, Crit Care Dept, Tarragona, Spain
CIBERES, Pere Virgili Hlth Inst, Tarragona, Spain
Hinojosa, CA:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Soni, NJ:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Gilley, RP:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Bustamante, CA:
Camino Dist Univ Adelita Char, Barranquilla, Colombia
Anzueto, A:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Univ Barcelona, Hosp Clin, Serv Pneumol, Barcelona, Spain
Levine, SM:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Peters, JI:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Aliberti, S:
Univ Milano Bicocca, Clin Pneumol, Monza, Italy
Sibila, O:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Med, Serv Pneumol, Barcelona, Spain
Chalmers, JD:
Univ Dundee, Dundee, Scotland
Waterer, GW:
Univ Western Australia, Royal Perth Hosp Unit, Sch Med & Pharmacol, Perth, WA, Australia
Martin-Loeches, I:
St James Hosp, Trinity Ctr Hlth Sci, CIBERES, Dublin, Ireland
Bordon, J:
Providence Hosp, Infect Dis Sect, Dept Med, Washington, DC USA
Blanquer, J:
Hosp Clin Univ, Unidad Cuidados Intens Resp, Valencia, Spain
Sanz, F:
Consorci Hosp Gen Univ Valencia, Dept Pulmonol, Valencia, Spain
Marcos, PJ:
Univ Coruna UDC, CHUAC, Inst Invest Biomed A Coruna INIBIC, Serv Neumol, La Coruna, Spain
Rello, J:
Hosp Univ Vall dHebron, Crit Care Dept, CIBERES, Barcelona, Spain
Ramirez, J:
Univ Louisville, Div Infect Dis, Louisville, KY 40292 USA
Sole-Violan, J:
Hosp Univ Dr Negrin, Intens Care Unit, CIBERES, Las Palmas Gran Canaria, Spain
Luna, CM:
Univ Buenos Aires, Div Pulmonol, Hosp Clin, Div Pulm Med,Dept Med, Buenos Aires, DF, Argentina
Feldman, C:
Charlotte Maxeke Johannesburg Acad Hosp, Dept Internal Med, Johannesburg, South Africa
Univ Witwatersrand, Fac Hlth Sci, Johannesburg, South Africa
Witzenrath, M:
Charite Univ Med Berlin, Dept Infect Dis & Pulm Med, Berlin, Germany
SFB TR84 Innate Immun Lung, Berlin, Germany
Wunderink, RG:
Northwestern Univ, Dept Med, Div Pulm & Crit Care Med, Feinberg Sch Med, Chicago, IL 60611 USA
Stolz, D:
Univ Basel Hosp, Clin Pulm Med & Resp Cell Res, Basel, Switzerland
Wiemken, TL:
Univ Louisville, Div Infect Dis, Louisville, KY 40292 USA
Shindo, Y:
Nagoya Univ, Grad Sch Med, Inst Adv Res, Nagoya, Aichi, Japan
Nagoya Univ, Grad Sch Med, Dept Resp Med, Nagoya, Aichi, Japan
Dela Cruz, CS:
Yale Univ, Sch Med, Sect Pulm Crit Care & Sleep Med, New Haven, CT USA
Orihuela, CJ:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
Univ Alabama Birmingham, Dept Microbiol, Birmingham, AL 35294 USA
Restrepo, MI:
Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA
South Texas Vet Hlth Care Syst, San Antonio, TX USA
Green Accepted, Green Submitted
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