ABSTRACT
Septic shock is the most frequent cause of death in intensive care units. Despite major advances in antimicrobial therapy, critical care and surgical techniques, there has been little improvement in morbidity or mortality due to sepsis or septic shock. The aim of this study was to evaluate the role of vascular cell adhesion molecule-1 [VCAM-1] and intercellular adhesion molecule-1 [ICAM-1] in sepsis, septic shock, haemodynamic changes and outcome. Thirty intensive care unit patients suffering from sepsis with or without shock were subjected to blood culture, culture from the site of infection if possible, blood gases analysis, acute physiology and chronic health evaluation score [APACHE II] at baseline, multiple organ failure score on day one [MOF1], cummulative organ failure score [MOFC] on day 5, haemodynamic measurements, as well as serum VCAM-1 and ICAM-1 levels for 5 days after admission. Ten healthy control subjects were also included in the study. The most common site of infection was the chest, the isolates were mostly Gram negative [60%of cases], 9 patients [30%] had positive blood cultures. Serum ICAM-1 and VCAM-1 levels gradually increased from a baseline till day 5 of the study and were significantly higher in patients on admission [62 +/- 20.21, 404.67 +/- 130.85 ng/ml, respectively] than in the control group [14.0 +/- 4.71, 128.0 +/- 34.9 ng/ml respectively], [P=0.00]. They were higher in shocked than in non-shocked patients, and significantly so in non-survivors than in survivors and in patients with positive blood cultures than in those with negative blood cultures, throughout the study period [P=0.00]. A significant positive correlation was observed between serum ICAM-1 and VCAM-1 levels on one hand, and APACHE II as well as both organ failure scores for the 1st day or cumulative on the other hand. We conclude that these adhesion molecules could be measured in critically ill septic patients to predict prognosis and guide therapy
ABSTRACT
Cardiac disease is the most frequent cause of sudden death. Moreover, the beginning of myocardial damage does not necessarily conincide with the appearance of symptoms, and therefore an asymptomatic period may ensue. One of the most difficult problems that face the critical care clinicians and forensic pathologists is to diganose sudden death in subjects with acute cardiac processes that progressed rapidly, with non-specific symptoms in many cases, and led to death without obvious morphological alterations. In recent years, many researches has been done to look for rapid, sensitive and specific cardiac markers that can assist critical care clinicians and forensic pathologists to make an early diangosis of acute myocardial infarction [AMI]. The latest markers available in market include troponins [I and T], creatine kinase [CK] and myoglobin. Cardiac troponin I [cTnI] is eventually a more sensitive, and a more reliable serum marker than cardiac troponin [cTnT] for the determination of damaged cardiac tissue following AMI. The aim of the present work is to test the prognositc value and reliability of measuring levels of certain blood biochemical markers for diangosing death due to acute myocardial infarction. The study was conducted at the Critical Care Department Units of Alexandria Main University Hospital. It was carried out on 62 selected cases suffering from extensive acute myocardial infarction. A spectal sheet was designed to collect the required information. Follow up of the patients was carried out till either improvement or death. Blood was obtained from all patient for cardiac markers assays: on admission, six hours after admission, and two hours postmortem for those who died [femoral vein]. Serum samples were tested for Cardiac troponin I [cTnI], Myoglobin and Creatine kinase MB [CK-MB]. Aditional 10 control deaths were included in the study [non-AMI deaths]. The results of the present study revealed that statistically significant differences were obtained for cTnI, myoglobin and CK-MB between Survived-MI cases and Non-Survived ones on admission and 6 hours later. Similarly, the concentrations of the three studied biochemical parameters in myocardial infarction [MI] patients, 6 hours from admission and 2 hours after death showed statistically significnat differences. Furthermore, the study showed postmortem significantly higher serum levels of these cardiac markers in deaths due to AMI as compared to deaths due to Non-MI. When comparing the cut off values of the 3 cardiac markers, it was found that measuring cTn I and CK-MB provide prognositc information that permits the early identification of patients with AMI at increased risk of death, hence aggressive treatement is needed for them and claims of malpractice are ruled out