Adhesion molecules in pediatric intensive care patients with organ dysfunction syndrome.

Abstract

To determine serum concentrations of the soluble forms of vascular cell adhesion molecule 1 (VCAM-1), intracellular adhesion molecule 1 (ICAM-1), and E-selectin in ventilated neonatal and pediatric intensive care patients with varying severity of multiorgan dysfunction syndrome (MODS) with or without infection-triggered organ failure. Prospective pilot study, a level III neonatal and pediatric intensive care unit at a University children's Hospital. We studied 22 ventilated pediatric (n=15) and neonatal (n=7) intensive care patients (aged 3 days-16 years). Inclusion criteria were mechanical ventilation and signs of at least one additional organ dysfunction (cardiovascular, respiratory, neurological, hematological, or renal). Serum concentrations of the adhesion molecules were analyzed on the day of maximum organ dysfunction score and were quantitated by a sandwich ELISA technique. The overall mortality rate was 36% (8/22). Dysfunction of three or more organ systems was defined as MODS and was associated with a significant increase in VCAM-1 serum levels relative to dysfunction of three or fewer organ systems [median 1239 ng/ml (IQR 928-1615) vs. 766 ng/ml (644-915)]. A significant difference in E-selectin serum levels was found between organ failure of infectious (median 131 ng/ml, IQR 112-146) and noninfectious origin (68 ng/ml 49-105). Determination of adhesion molecules in pediatric intensive care patients raises the possibility of more specific pathophysiological understanding. E-selectin showed significantly different serum levels between infectious and noninfectious causes of organ failure.