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.
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