Longitudinal course and clinical significance of TGF-β1, sL- and sE-Selectins and sICAM-1 levels during severe acute stress in children

Objectives: To elucidate the potential role of circulating levels of transforming growth factor-beta1 (TGF-β1), soluble intercellular adhesion molecule-1 (sICAM-1), soluble L- and sE-Selectins (sL- and sE-Selectins) in children with sepsis, traumatic brain injury (TBI) or acute respiratory distress syndrome (ARDS). Design and methods: Levels of TGF-β1, sICAM-1, L- and sE-Selectins were determined using solid-phase sandwich enzyme-linked immunosorbent assay in plasma of 10 patients with sepsis, 10 patients with TBI, 10 patients with ARDS, compared to 10 ventilated controls with chronic illness but not in acute stress, on days 1, 3, 5, 7 and 10. Results: The highest values of sICAM-1 were observed in patients with TBI (p < 0.001) and those of sE-Selectin in patients with sepsis (p = 0.0001). Patients in the control group did not show an elevation of sE-Selectin and sICAM-1 levels longitudinally. Increased levels of measured molecules (TGF-β1, p < 0.02, sE-Selectin, p < 0.02, sL-Selectin, p = 0.06, sICAM-1, p < 0.03) were demonstrated among survivors in the sepsis and ARDS groups of patients and were positively correlated with length of stay (p < 0.04) and mechanical ventilation (p < 0.001). Conclusions: A sustained increase of adhesion molecules occurs during acute stress in children which may contribute to morbidity in patients with sepsis (sE-Selectin) or traumatic brain injury (sICAM-1). Suppression of the expected response of sE-Selectins, s-ICAM-1 and TGF-β1 is associated with poor outcome.