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Increased Endothelial Injury in Septic Patients With Coronary Artery Disease^*

^* From the Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Mitte, Humboldt University of Berlin, Germany.

Correspondence to: Claudia Spies, MD, Department of Anesthesiology and Intensive Care, University Hospital Charité, Campus Mitte, Humboldt University of Berlin, Schumannstr. 20/21, 10098 Berlin, Germany; e-mail: claudia.spies{at}charite.de

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.

Key Words: adhesion molecules • coronary artery disease • cytokines • nitric oxide • sepsis

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