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Clinical Trial
. 2005 Aug;9(4):R323-30.
doi: 10.1186/cc3532. Epub 2005 May 13.

Time course of endothelial damage in septic shock: prediction of outcome

Ortrud Vargas Hein  1 , Klaudia Misterek, Jan-Peer Tessmann, Vera van Dossow, Michael Krimphove, Claudia Spies
Affiliations
Clinical Trial

Time course of endothelial damage in septic shock: prediction of outcome

Ortrud Vargas Hein et al. Crit Care. 2005 Aug.

Abstract

Introduction: Endothelial damage accounts greatly for the high mortality in septic shock. Higher expression of mediators (IL-6, IL-8, soluble intercellular adhesion molecule 1 [sICAM-1], soluble endothelial-linked adhesion molecule 1 [sELAM-1]) have been described for non-survivors in comparison with survivors. We investigated the predictive value of the mediators IL-6, IL-8, sELAM-1 and sICAM-1 and their time course in intensive care unit patients who developed septic shock with respect to outcome.

Materials and methods: We measured serum levels of IL-6, IL-8, sELAM-1 and sICAM-1 in 40 intensive care unit patients who developed septic shock. Measurements were performed until death or until resolution of septic shock. Clinical and laboratory data were also recorded.

Results: After 48 hours the levels of sELAM-1 and sICAM-1 increased in non-survivors and decreased in survivors. sELAM-1 was predictive for outcome on the third day (P = 0.02) and the fourth day (P = 0.02) after diagnosis of septic shock. This difference in the time course between survivors and non-survivors occurred 7 days before death of the patients (median, 10 days). sICAM-1 levels increased significantly in non-survivors over the study period (P < 0.001). sELAM-1 (P = 0.04), IL-6 (P = 0.04) and IL-8 (P = 0.008) were significantly higher in non-survivors over the whole study period. The age and norepinephrine dose >0.5 mug/kg/min were significantly different between the groups.

Conclusion: sELAM-1 showed a markedly opposing course after 48 hours of septic shock. This adhesion molecule may be a useful early predictor of disease severity in the course of septic shock after early initial treatment of the patients, and might suggest considering endothelial-restoring therapy.

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Figures

Figure 1
Figure 1
IL-6 for survivors and non-survivors over time.
Figure 2
Figure 2
IL-8 for survivors and non-survivors over time.
Figure 3
Figure 3
Soluble endothelial-linked adhesion molecule 1 (sELAM-1) for survivors and non-survivors over time. * Significant difference (P < 0.05) for sELAM-1 between survivors and non-survivors.
Figure 4
Figure 4
Soluble intercellular adhesion molecule 1 (sICAM-1) for survivors and non-survivors over time.
See this image and copyright information in PMC

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