Am. J. Respir. Crit. Care Med., Volume 156, Number 2, August 1997, 431-437

Soluble E-Selectin Levels in Sepsis and Critical Illness
Correlation with Infection and Hemodynamic Dysfunction

C. JAMES CUMMINGS, CURTIS N. SESSLER, L. DAWSON BEALL, BERNARD J. FISHER, AL M. BEST, and ALPHA A. FOWLER III

From the Division of Pulmonary and Critical Care Medicine, Department of Medicine, and the Department of Biostatistics, Medical College of Virigina Hospitals/Virginia Commonwealth University, Richmond, Virginia; and Otsuka American Pharmaceutical, Inc., Rockville, Maryland

E-selectin, an early mediator of leukocyte-endothelial adhesion, is expressed on activated endothelium. Soluble E-selectin is present in the supernatant of cytokine-activated endothelial cells and elevated serum levels are found in a variety of inflammatory conditions. We documented elevated E-selectin serum levels in 119 critically ill medical ICU patients (log transformed mean E-selectin level, measured by ELISA, was 5.28 ng/ml) compared to normal volunteers (1 ng/ml). Forty-three patients with culture-positive sepsis had higher (p < 0.05) E-selectin levels (15.39 ng/ml) than 24 patients with culture-negative sepsis (4.87 ng/ml), 44 with noninfectious SIRS (2.33 ng/ml), and eight without SIRS (1.97 ng/ml). E-selectin levels related strongly to the degree of hemodynamic compromise (p < 0.0001). Further analysis demonstrated microbiological status and hemodynamic status to be independent variables related to E-selectin level. Day 1 E-selectin levels correlated positively with peak organ failure score over the course of ICU hospitalization (r = 0.30, p = 0.001) and were higher (p < 0.05) for nonsurvivor (10.61 ng/ml, n = 26) than survivors (4.35 ng/ml, n = 93). We conclude that soluble E-selectin levels are higher in serum of patients with microbiologically documented sepsis than in other critically ill medical ICU patients. Day 1 E-selectin levels correlate highly with hemodynamic compromise and modestly with subsequent organ dysfunction and survival.

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