Sepsis Research Paper

Serum Soluble Endothelial Selectin Levels in Critically Ill Pediatric Septic Patients

Ahmed Abd El-Basset Abo Elezz1, Rasha Mohamed Gamal El Shafiey1, Maaly Mohamed Mabrouk2

Department of Pediatrics1, and Clinical Pathology2, Faculty of Medicine, Tanta University, Egypt.

Abstract

Background: Sepsis is the most common cause of death in infants and children worldwide. Severe infection and sepsis are among one of the most devastating problems of patients who are critically ill, as these conditions are characterized, at least in part, by altered leukocyte endothelial interaction. Different studies demonstrated that sE-selectin was being elevated in septic patients and were highly correlated with hemodynamic compromise in adult ICU patients. Therefore,

Further deterioration leads to septic shock (severe sepsis plus the persistence of hypoperfusion or hypotension despite adequate fluid resuscitation or a requirement for vasoactive agents), multiple organ dysfunction syndrome, and possibly death. This complex clinical spectrum is a leading cause of death in children worldwide. Early recognition and treatment may improve the outcome.

C-reactive protein level on the 1st day of admission and serum soluble E-selectin levels were higher in non survivors compared to survivors, but without being statistically significant (P value > 0.05 for both). Also, the values of CRP on the 3rd day of admission were significantly higher than those of the 1st day of admission in both survivors and non survivors (P value = 0.001) (Table 3).

Results of the multivariate analysis (Table 4) showed that neither E-selectin nor CRP on days 1 or 3, or SOFA score correlated independently with survival in studying patients (p 0.549, 0.647, 0.097, and 0.772, respectively). However, PRISM III score correlated strongly and independently with the survival (p, 0.000).

We further studied serum sE-selectin levels at ICU admission as a predictor of outcome in the studied patients. The AUC at baseline measurements was 0.664±0.061 (95% confidence interval, 0.545–0.783; p=0.014). Thus, a sE-selectin concentration of 197.2ng/ml at ICU admission was identified as the optimum threshold to distinguish survival and non survival patients with a sensitivity of 87% and specificity of 48% (Fig.