PURPOSE: Vascular endothelial growth factor (VEGF) causes vasodilatation and increased vascular permeability, both common in systemic inflammatory response syndrome (SIRS) patients. SIRS criteria are not extremely specific for underlying infection. Whether serum VEGF is elevated in SIRS (from all causes: inflammatory or non-inflammatory) is unclear. This study’s objectives 1) are serum VEGF levels elevated in patients with SIRS criteria, 2) if elevated can VEGF differentiate between patients with inflammatory vs non-inflammatory mediated SIRS criteria, 3) does a relationship exist between disease severity and VEGF levels.
METHODS: Patients selected met at least two of four SIRS criteria within twenty-four hours of ICU admission. Patients are divided into SIRS (Group 1) and “Faux” SIRS (Group 2.) Group 1 compared to Group 2 are patients with an initiating event/disease process causing systemic inflammatory mediator release. VEGF levels (pg/ml) are determined by ELISA. Admission (and daily for 3 days) Apache II scores, multiorgan organ dysfunction (MOD), third spacing, vital signs, laboratory studies and survival are correlated with VEGF.
RESULTS: Group 1 (n=5) had sepsis (n=4) and severe diarrhea; Group 2 (n=7) had acute respiratory failure (n=4), gastrointestinal bleeding (n=2), CHF. Group 1 had significantly higher VEGF (p<0.01) compared to Group 2 (621 +/− 120 vs. 76 +/− 22 Day 1, 747 +/− 154 vs. 156 +/− 45 Day 2, 538 +/− 112 vs.119 +/− 34 Day 3). Normal controls (n=3) VGEF 146 +/− 34. APACHE was nonsignificantly higher in Group 1 vs. 2 (21 +/− 5 & 15 +/− 4). There was no correlation between VEGF and age, vital signs, MOD, third spacing, leukocyte counts, hypoxemia, hemoglobin, platelets, creatinine, or anion gap on any day. Survival was similar in each Group.
CONCLUSION: VEGF levels 1) are higher in patients with SIRS criteria secondary to inflammatory mediators, 2) could be a SIRS mediator and/or marker, 3) are nonsignificantly correlated with APACHE II scores.
CLINICAL IMPLICATIONS: If our ongoing study confirms a significant role exists for VEGF in SIRS, studies with anti-VEGF therapies would be indicated.
DISCLOSURE: Deborah Rowlands, None.