The Significance of Increased Circulating Intercellular Adhesion Molecule 1 (cICAM-1) in Neonatal Sepsis

ABSTRACT

PURPOSE: The early and efficient diagnosis of neonatal sepsis still remains a difficult task. Reliable laboratory test is not available yet and treatment is mainly based on the physical appearance of infants. And high number of negative blood cultures in cases of clinically diagnosed sepsis further emphasize the need for a more reliable index for early diagnosis. Intercellular adhesion molecule 1 (ICAM-1) has been known important in various immunological processes early in inflammation, and recently circulating ICAM-1 (cICAM-1) has been detected in serum and supernatant of cytokine-activated endothelial cell cultures. The purpose of our study was to evaluate cICAM-1 as a marker in neonatal sepsis. METHODS: Using enzyme linked immunosorbent assay (ELISA), we measured serial cICAM-1 over the first week of admission in 48 neonates who were admitted at NICU due to clinically suspected sepsis. RESULTS: We found the levels of cICAM-1 on admission in 9 culture proven and 20 clinically dignosed septic neonates (1723.3+/-669.7ng/ml and 994.9+/-358.5ng/ml, respectively) were significantly higher (P<0.001) than those in neonates showing systemic inflammatory signs without evidence of sepsis and healthy controls (380.6+/-235.8ng/ml and 238.8+/-96.6ng/ml, respectively). The cICAM-1 levels on admission in septic neonates with high severity score were higher than those with low severity score (P<0.01). Fatal cases exhibited higher cICAM-1 on admision than did survivals (1710.8+/-634.5ng/ml versus 963.4+/-411.4ng/ml, P<0.0001) and there seemed to be a positive correlation between cICAM-1 levels and mortality. The elevation of cICAM-1 on admission in septic neonates appeared earlier than the rise of c-reactive protein (CRP) above 10mg/L. CONCLUSIONS: The measurement of cICAM-1 on admisson might be useful for the early detection of neonatal sepsis and high cICAM-1 level suggests poor prognosis.