The dynamics of serum vascular endothelial cadherin levels and its relationship with prognosis in patients with acute respiratory distress syndrome induced by sepsis

Abstract

Objective To investigate the prognostic significance of serum vascular endothelial cadherine (VE-Cad) in patients with acute respiratory distress syndrome (ARDS) induced by sepsis. Methods A prospective observational study was performed between June 2015 and Dec 2017, and 48 ARDS patients induced by sepsis from intensive care unit (ICU) were enrolled. And 30 healthy volunteers were enrolled as control. ARDS group was divided into mild group (n=17), moderate group (n=18) and severe group (n=13). The dynamic levels of serum VE-Cad, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were monitored at day 1, 3 and 7 of admission. Clinical data including extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), lung injury score (LIS), APACHEⅡand SOFA were also collected. The t-test or chi square test were used in the comparison between the two groups. One-way ANOVA was used for comparison among multiple groups. Results The serum VE-Cad level of septic group was higher than control group at day 1 of admission ([5.67±0.29] vs [0.28±0.03] g/L, t=101.2, P<0.01). The serum VE-Cad levels in the mild group, moderate group and severe group were (1.52±0.59), (3.45±0.68), and (4.68±0.53) g/L, respectively (F=15.45, P<0.01). There were positive correlation between VE-Cad levels and EVLWI, PVPI, LIS, TNF-α and IL-6 (r=0.640, 0.601, 0.507, 0.584, and 0.456, respectively, all P<0.01). The PaO2/FiO2and serum albumin level in death group (n=17) were lower than survival group (n=31) ([146.74±16.45] vs [245.42±12.13] mmHg [1 mmHg=0.133 kPa], t=23.72, P<0.01; [23.18±3.24] vs [29.16±3.45] g/L, t=5.865, P<0.01, respectively), and EVLWI , PVPI, LIS, serum lactate, mechanical ventilation time, 7 d fluid balance, APACHEⅡand SOFA in death group were all higher than survival group. The serum VE-Cad levels at day 1, 3 and 7 in death group were all higher than survival group ([4.72±0.96] vs [3.36±0.47] g/L, t=8.801; [3.87±0.28] vs [1.95±0.42] g/L, t=16.86; [3.92±0.53] vs [0.96±0.28] g/L, t=25.42, respectively, all P<0.01). The area under curve (AUC) of VE-Cad for ARDS outcome prediction was 0.878 with sensitivity of 100.00% and specificity of 58.06% with a cutoff of 3.035 g/L. Conclusion Serum VE-Cad level increases in patients with ARDS induced by sepsis, and positively correlates with disease severity, which could be a potential predictor for prognosis. Key words: Sepsis; Acute respiratory distress syndrome; VE-cadherin; Tumor necrosis factor-alpha; Prognosis