Eur J Pediatr Surg 2008; 18(6): 419-422
DOI: 10.1055/s-2008-1038908
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Plasma Soluble E-Selectin in Necrotising Enterocolitis

A. K. Khoo1 , N. J. Hall1 , N. Alexander1 , N. J. Evennett1 , A. Pierro1 , S. Eaton1
  • 1Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK
Further Information

Publication History

received June 23, 2008

accepted after revision July 7, 2008

Publication Date:
14 November 2008 (online)

Abstract

Aim: E-selectin is an important mediator of leukocyte-endothelial adhesion. It is expressed on activated endothelium, and shed into the circulation in its soluble form. In babies with necrotising enterocolitis (NEC), increased intestinal expression of E-selectin has been associated with multiple organ failure and an adverse outcome. The aim of this study was to determine whether increased circulating soluble E-selectin (sE-selectin) was associated with a worse prognosis. Methods: With ethical approval, plasma samples from 20 infants with Bell stage II and III NEC were analysed. Both pre- and postoperative samples were available in 6 infants. The severity of illness was assessed using a sequential organ failure assessment score (SOFA) specifically designed for use in NEC. Plasma concentration of sE-selectin was determined by ELISA. Data, which were not normally distributed, were compared by Spearman's rank correlation coefficient and Wilcoxon signed rank test. Results: Plasma sE-selectin was strongly negatively correlated with corrected gestational age at the time of sampling (r = − 0.425, p = 0.006). There was no association between plasma sE-selectin and outcome (death or survival to discharge), severity of intestinal disease (focal, multifocal or pan-intestinal), or SOFA score. Surgery for suspected perforation, however, caused a significant elevation in sE-selectin levels (p = 0.031). Conclusions: Plasma sE-selectin, a described marker of endothelial activation, is increased following surgery for NEC. However, prematurity appears to be the cause of an increase in sE-selectin level, confounding the potential use of sE-selectin levels as a predictor of severity of illness in NEC.

References

  • 1 Austgulen R, Arntzen K J, Haereid P E, Aag S, Dollner H. Infections in neonates delivered at term are associated with increased serum levels of ICAM‐1 and E-selectin.  Acta Paediatr. 1997;  86 274-280
  • 2 Ballabh P, Kumari J, Krauss A N, Shin J J, Jain A, Auld P A. et al . Soluble E-selectin, soluble L-selectin and soluble ICAM‐1 in bronchopulmonary dysplasia, and changes with dexamethasone.  Pediatrics. 2003;  111 461-468
  • 3 Bevilacqua M P, Nelson R M. Selectins.  J Clin Invest. 1993;  91 379-387
  • 4 Cowley H C, Heney D, Gearing A J, Hemingway I, Webster N R. Increased circulating adhesion molecule concentrations in patients with the systemic inflammatory response syndrome: a prospective cohort study.  Crit Care Med. 1994;  22 651-657
  • 5 Dollner H, Vatten L, Austgulen R. Early diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6, soluble tumour necrosis factor receptors and soluble adhesion molecules.  J Clin Epidemiol. 2001;  54 1251-1257
  • 6 Eaton S, Hall N, Rees C M, Pierro A. Necrotizing enterocolitis: pathogenesis, medical management and surgery.  Br J Intensive Care. 2004;  14 101-105
  • 7 Fasoli L, Turi R A, Spitz L, Kiely E M, Drake D, Pierro A. Necrotizing enterocolitis: extent of disease and surgical treatment.  J Pediatr Surg. 1999;  34 1096-1099
  • 8 Gearing A J, Hemingway I, Pigott R, Hughes J, Rees A J, Cashman S J. Soluble forms of vascular adhesion molecules, E-selectin, ICAM‐1, and VCAM‐1: pathological significance.  Ann N Y Acad Sci. 1992;  667 324-331
  • 9 Hall N J, Ali J, Pierro A, Eaton S. Total glutathione is not decreased in infants with necrotising enterocolitis.  J Pediatr Surg. 2005;  40 769-773
  • 10 Langouche L, Vanhorebeek I, Vlasselaers D, Vander P S, Wouters P J, Skogstrand K. et al . Intensive insulin therapy protects the endothelium of critically ill patients.  J Clin Invest. 2005;  115 2277-2286
  • 11 Ley K, Laudanna C, Cybulsky M I, Nourshargh S. Getting to the site of inflammation: the leukocyte adhesion cascade updated.  Nat Rev Immunol. 2007;  7 678-689
  • 12 Lin P W, Stoll B J. Necrotising enterocolitis.  Lancet. 2006;  368 1271-1283
  • 13 Ng P C, Cheng S H, Chui K M, Fok T F, Wong M Y, Wong W. et al . Diagnosis of late onset neonatal sepsis with cytokines, adhesion molecule, and C-reactive protein in preterm very low birthweight infants.  Arch Dis Child Fetal Neonatal Ed. 1997;  77 F221-F227
  • 14 Okajima K, Uchiba M, Murakami K, Okabe H, Takatsuki K. Plasma levels of soluble E-selectin in patients with disseminated intravascular coagulation.  Am J Hematol. 1997;  54 219-224
  • 15 Okajima K, Harada N, Sakurai G, Soga Y, Suga H, Terada T. et al . Rapid assay for plasma soluble E-selectin predicts the development of acute respiratory distress syndrome in patients with systemic inflammatory response syndrome.  Transl Res. 2006;  148 295-300
  • 16 Pierro A, Hall N. Surgical treatments of infants with necrotizing enterocolitis.  Semin Neonatol. 2003;  8 223-232
  • 17 Rees C M, Eaton S, Pierro A. Trends in infant mortality from necrotizing enterocolitis in England and Wales and the USA.  Arch Dis Child. 2008; 
  • 18 Stefanutti G, Lister P, Smith V V, Peters M J, Klein N J, Pierro A. et al . P-Selectin expression, neutrophil infiltration and histological injury in neonates with necrotizing enterocolitis.  J Pediatr Surg. 2005;  40 942-948
  • 19 Upperman J S, Potoka D, Grishin A, Hackam D, Zamora R, Ford H R. Mechanisms of nitric oxide-mediated intestinal barrier failure in necrotizing enterocolitis.  Semin Pediatr Surg. 2005;  14 159-166
  • 20 Wyble C W, Desai T R, Clark E T, Hynes K L, Gewertz B L. Physiologic concentrations of TNFalpha and IL-1beta released from reperfused human intestine upregulate E-selectin and ICAM‐1.  J Surg Res. 1996;  63 333-338

PhD Simon Eaton

Department of Paediatric Surgery
Institute of Child Health

30, Guilford Street

London WC1N 1EH

UK

Email: s.eaton@ich.ucl.ac.uk

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