He Jiawei, Duan Meili, Zhuang Haizhou
Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Heliyon. 2024 Oct 31;10(21):e40003. doi: 10.1016/j.heliyon.2024.e40003. eCollection 2024 Nov 15.
Endothelial cell dysfunction and microcirculatory disturbances play crucial roles in the pathogenesis of sepsis. This systematic review and meta-analysis explored the relationship of the plasma levels of the key endothelial proteins intercellular adhesion molecule 1 (ICAM1) and vascular cell adhesion molecule 1 (VCAM1) with clinical outcomes in patients with sepsis.
MEDLINE and EMBASE were searched through November 28, 2023. ICAM1 and VCAM1 levels and patient outcomes were evaluated. The primary outcome was the relationship of sepsis with ICAM1 or VCAM1. The secondary outcomes were the relationships of septic shock and multiple-organ dysfunction syndrome (MODS) with ICAM1 and VCAM1. Variables were compared using standardized mean differences (SMDs) with 95 % confidence intervals (CIs).
Forty-one studies were included. ICAM1 (SMD = 1.12, 95 % CI = 0.67, 1.57; P < 0.00001) and VCAM1 (SMD = 0.65; 95 % CI = 0.17, 1.13; P = 0.008) were associated with sepsis. Similarly, both ICAM1 (SMD = 2.30; 95 % CI = 1.30, 3.31; P < 0.00001) and VCAM1 (SMD = 0.93; 95 % CI = 0.27, 1.59; P = 0.006) were associated with MODS. ICAM1 was associated with septic shock (SMD = 1.93; 95 % CI = 0.55, 3.30; P = 0.006), overall mortality (SMD = -1.18; 95 % CI = -1.76, -0.61; P < 0.0001), and sepsis-related mortality (SMD = -0.64; 95 % CI = -0.88, -0.39; P < 0.00001). VCAM1 was associated with overall mortality (SMD = -0.71; 95 % CI = -1.02, -0.40; P < 0.00001), sepsis-related mortality (SMD = -0.62; 95 % CI = -1.14, -0.10; P = 0.02), and MODS-related mortality (SMD = -0.55; 95 % CI = -0.89, -0.21; P = 0.002).
Elevated plasma ICAM1 and VCAM1 levels could increase the risks of sepsis, septic shock, MODS, and mortality.
内皮细胞功能障碍和微循环紊乱在脓毒症发病机制中起关键作用。本系统评价和荟萃分析探讨了关键内皮蛋白细胞间黏附分子1（ICAM1）和血管细胞黏附分子1（VCAM1）的血浆水平与脓毒症患者临床结局的关系。
检索截至2023年11月28日的MEDLINE和EMBASE数据库。评估ICAM1和VCAM1水平及患者结局。主要结局是脓毒症与ICAM1或VCAM1的关系。次要结局是感染性休克和多器官功能障碍综合征（MODS）与ICAM1和VCAM1的关系。使用标准化均数差（SMD）及95%置信区间（CI）比较变量。
纳入41项研究。ICAM1（SMD = 1.12，95%CI = 0.67，1.57；P < 0.00001）和VCAM1（SMD = 0.65；95%CI = 0.17，1.13；P = 0.008）与脓毒症相关。同样，ICAM1（SMD = 2.30；95%CI = 1.30，3.31；P < 0.00001）和VCAM1（SMD = 0.93；95%CI = 0.27，1.59；P = 0.006）均与MODS相关。ICAM1与感染性休克（SMD = 1.93；95%CI = 0.55，3.30；P = 0.006）、总体死亡率（SMD = -1.18；95%CI = -1.76，-0.61；P < 0.0001）及脓毒症相关死亡率（SMD = -0.64；95%CI = -0.88，-0.39；P < 0.00001）相关。VCAM1与总体死亡率（SMD = -0.71；95%CI = -1.02，-0.40；P < 0.00001）、脓毒症相关死亡率（SMD = -0.62；95%CI = -1.14，-0.10；P = 0.02）及MODS相关死亡率（SMD = -0.55；95%CI = -0.89，-0.21；P = 0.002）相关。
血浆ICAM1和VCAM1水平升高会增加脓毒症、感染性休克、MODS及死亡风险。
