Association of soluble and cell-linked selectins, multiple organ dysfunction and systemic inflammatory response syndrome

Background

The soluble members of the selectin family (L-, E- and P-selectin) as well as the cell-linked L-selectin play a key role in leukocyte - endothelial-thrombocyte interaction as they are known to promote leukocyte rolling and tethering under flow conditions [1] .

Altered sL-, sP- and sE-selectin levels are made responsible for the development of different complications in intensive care medicine as ARDS [2], reperfusion injury [3] and other inflammatory disorders.

Objective

To determine if the plasma levels of L-, E-, and P-selectin and the expression of L-selectin on different leukocyte subpopulations in the very early post-traumatic phase and the first critical week on the ICU differ between patients with multiple organ dysfunction (MODS) or SIRS and those without, 51 polytraumatized patients were examined.

Methods

Blood withdrawn from 51 severely injured patients (Injury Severity Score 17-75, average 32.5; age 16-89, average 38.4 years) at 10 time points from the site of accident during the following 6 days (144 h) in the ICU was studied by using the Coulter Epics XL flow cytometer and monoclonal antibodies against CD3, CD19, CD14 and CD62L. Cytometry data are shown as the mean fluorescence of CD62L on B- and T-lymphocytes, monocytes and PMN. Soluble L-, E- and P-selectin levels in plasma were measured by using commercial ELISAs by R&D and Bender. Statistical significances were calculated with Wilcoxon test.

Results

As an example for the alterations in expression of CD62L on leukocytes, Table 1 shows the significant difference in CD62L (LECAM-1) on CD14+ peripheral mononuclear cells in patients who reached = 5 points in the daily Organ Dysfunction Score (Goris et al) during day 1 and 6 (P = 0.0006), similar to CD62L on CD19+ B-lymphocytes (P = 0.0001) and on CD3+ T-lymphocytes (P = 0.0001) (data not shown).

Table 2 illustrates the increase of sL-selectin plasma levels starting 48 h after trauma and growing to day six in patients who will develop severe MODS (ie = 5 points in the ODF score) after the 6th post-traumatic day, compared to those with moderate (1-4 points) and without organ dysfunction (P = 0.0001).

Table 3 shows the high increase of soluble E-selectin beginning 24 h after trauma and remaining on elevated level in patients who will develop severe MODS (ie = 5 points in the ODF score) after the 6th post-traumatic day, compared to those with moderate (1-4 points) and without organ dysfunction (P = 0.0018).

Table 1

Table 2

Table 3

Discussion

While the early cellular response on multiple trauma shows differences in the amount of expressed CD62L on leukocytes parallel to the clinical situation concerning organ dysfunction, the sE- and sL-selectin levels are increased in patients with a later onset of MODS. Any prospective value of selectin levels for early clinical intervention should be the subject of further investigations.