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Time course of endothelial damage in septic shock: prediction of outcome

机译：败血性休克中内皮损伤的时程：预后的预测

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IntroductionEndothelial damage accounts greatly for the high mortality in septic shock. Higher expression of mediators (IL-6, IL-8, soluble intercellular adhesion molecule 1 [sICAM-1], soluble endothelial-linked adhesion molecule 1 [sELAM-1]) have been described for non-survivors in comparison with survivors. We investigated the predictive value of the mediators IL-6, IL-8, sELAM-1 and sICAM-1 and their time course in intensive care unit patients who developed septic shock with respect to outcome.Materials and methodsWe measured serum levels of IL-6, IL-8, sELAM-1 and sICAM-1 in 40 intensive care unit patients who developed septic shock. Measurements were performed until death or until resolution of septic shock. Clinical and laboratory data were also recorded.ResultsAfter 48 hours the levels of sELAM-1 and sICAM-1 increased in non-survivors and decreased in survivors. sELAM-1 was predictive for outcome on the third day (P = 0.02) and the fourth day (P = 0.02) after diagnosis of septic shock. This difference in the time course between survivors and non-survivors occurred 7 days before death of the patients (median, 10 days). sICAM-1 levels increased significantly in non-survivors over the study period (P 0.5 μg/kg/min were significantly different between the groups.ConclusionsELAM-1 showed a markedly opposing course after 48 hours of septic shock. This adhesion molecule may be a useful early predictor of disease severity in the course of septic shock after early initial treatment of the patients, and might suggest considering endothelial-restoring therapy.
机译：引言内皮细胞损伤是导致败血性休克高死亡率的重要原因。与幸存者相比，非幸存者的介质（IL-6，IL-8，可溶性细胞间粘附分子1 [sICAM-1]，可溶性内皮连接粘附分子1 [sELAM-1]）表达更高。我们研究了IL-6，IL-8，sELAM-1和sICAM-1介体在重症感染性休克重症监护病房中对患者预后的预测价值及其时程。材料和方法我们测量了血清IL- 6，IL-8，sELAM-1和sICAM-1在40名发生败血性休克的重症监护病房患者中。进行测量直至死亡或感染性休克消失。结果还记录了48小时后非存活者的sELAM-1和sICAM-1水平升高，存活者下降。 sELAM-1可在感染性休克诊断后的第三天（P = 0.02）和第四天（P = 0.02）预测结果。幸存者与非幸存者之间在时间上的差异发生在患者死亡前7天（中位数为10天）。在研究期间，非存活者的sICAM-1水平显着升高（两组之间P分别为0.5μg/ kg / min显着不同。）结论：败血性休克48小时后，ELAM-1的进程明显相反。在早期对患者进行早期治疗后，在感染性休克过程中对疾病严重程度的早期预测非常有用，并且可能建议考虑使用内皮修复治疗。

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