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Elevated Vascular Endothelial Injury Markers Are Associated With the Development of Multiorgan Failure and Mortality in Patients With Severe Sepsis and Septic Shock FREE TO VIEW

Bravein Amalakuhan, MD; Sheila Habib, MD; Mandeep Mangat, MD; Reyes Luis, MD; Antonio Anzueto, MD; Stephanie Levine, MD; Jay Peters, MD; Carlos Orihuela, PhD; Marcos Restrepo, MD
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University of Texas Health and Science Center at San Antonio, San Antonio, TX

Chest. 2015;148(4_MeetingAbstracts):190A. doi:10.1378/chest.2246855
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SESSION TITLE: Biomarkers in Severe Sepsis and Septic Shock

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM

PURPOSE: Vascular endothelial injury is one of the mechanisms associated with the development of multi-organ failure (MOF) and mortality in patients with severe sepsis and septic shock. Limited data are available regarding early recognition of vascular endothelial injury markers in patients with sepsis. The objective of this study was to determine the association of elevated vascular endothelial injury markers and the development of MOF and mortality among patients with severe sepsis and septic shock.

METHODS: This study is a secondary data analysis of a prospective cohort of adult patients with severe sepsis and septic shock, admitted to two tertiary intensive care units (ICU) from 2007-2012. Exclusion criteria included subjects with immunosuppression. The following markers of vascular endothelial injury were drawn at the time of initial organ dysfunction (within 24-48 hours): Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1) and Vascular Endothelial Growth Factor (VEGF). The primary outcome was the development of MOF. Secondary outcomes included mortality in-hospital and at 28-days. Multivariate analysis controlling for severity of illness with APACHE II scores were performed for the primary and secondary outcomes.

RESULTS: 48 patients were enrolled; 29 (60%) developed MOF. Severe septic patients with MOF had higher levels of VCAM-1 (p<0.01) and ICAM-1 (p<0.02), but not higher VEGF levels (p=0.7), compared to patients with single organ failure. The area under the curve (AUC) to predict MOF was 0.71 for VCAM-1, 0.73 for ICAM-1, and 0.54 for VEGF. Only VCAM-1 was associated with in-hospital (p<0.04) and 28-day mortality (p<0.04) respectively.

CONCLUSIONS: Elevated levels of vascular endothelial injury markers, specifically VCAM-1 and ICAM-1 are associated with MOF in patients with severe sepsis and septic shock. High VCAM-1 levels are associated with increased in-hospital and 28-day mortality.

CLINICAL IMPLICATIONS: Further studies should evaluate the prognostic role of these vascular endothelial injury markers and potential interventions to prevent MOF and maintain vascular endothelial integrity.

DISCLOSURE: The following authors have nothing to disclose: Bravein Amalakuhan, Sheila Habib, Mandeep Mangat, Reyes Luis, Antonio Anzueto, Stephanie Levine, Jay Peters, Carlos Orihuela, Marcos Restrepo

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