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Increased endothelial injury in septic patients with coronary artery disease
1Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Mitte, Humboldt University of Berlin, Germany.
Insights
Septic patients with coronary artery disease (CAD) show elevated soluble intercellular adhesion molecule-1 (sICAM-1) and other markers indicating endothelial injury. These markers did not predict survival in early sepsis.
Area of Science:
- Cardiovascular Medicine
- Critical Care Medicine
- Biomarkers
Background:
- Plasma levels of soluble intercellular adhesion molecule-1 (sICAM-1) may identify sepsis patients at risk for cardiovascular complications.
- The influence of pre-existing coronary artery disease (CAD) on these markers is not well understood.
Purpose of the Study:
- To investigate differences in plasma adhesion molecules, nitric oxide, and cytokines between septic patients with and without pre-existing CAD.
- To assess the impact of CAD on hemodynamic parameters during sepsis.
Main Methods:
- A prospective study was conducted in a surgical intensive care unit.
- Forty-four septic patients (24 with CAD) were analyzed.
- Hemodynamic measurements and blood samples were collected during early (within 12h) and late (72h later) sepsis.
Main Results:
- Septic patients with CAD exhibited significantly elevated sICAM-1 in both early and late sepsis.
- Soluble endothelial-linked adhesion molecule (sE-selectin) and cyclic guanosinomonophosphate (cGMP) were increased in late sepsis among CAD patients.
- CAD patients showed diminished oxygen delivery and mixed venous oxygen saturation, with an increased oxygen extraction ratio.
Conclusions:
- Elevated sICAM-1, sE-selectin, and cGMP levels in septic patients with CAD suggest increased endothelial injury.
- These biomarkers did not effectively predict unknown CAD or survival outcomes in early sepsis.
Study Objective:
Recently, it was proposed that soluble intercellular adhesion molecule (sICAM)-1 plasma levels may allow subgroup identification of patients at risk for cardiovascular complications during sepsis. However, the impact of preexisting coronary artery disease (CAD) on these results has not yet been tested. The aim of this study was to investigate whether plasma levels of adhesion molecules, nitric oxide, and cytokines differ between septic patients with or 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 thereafter (late sepsis). Soluble adhesion molecules and cytokines were determined using commercially available enzyme-linked immunosorbent assay kits, cyclic guanosinomonophosphate (cGMP) by competitive radioimmunoassay, and nitrite/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 sepsis. Oxygen consumption did not significantly differ between groups. Oxygen 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 by the elevated levels of sICAM-1, sE-selectin, and cGMP in septic patients with preexisting CAD. These parameters, however, failed to serve as predictors for unknown CAD or chances for survival in early sepsis.