Intensive Care Med (2004) 30:867–874 DOI 10.1007/s00134-004-2253-1
Bruno Mgarbane Philippe Marchal Anne Marfaing-Koka Olivier Belliard Frdric Jacobs Isabelle Chary Franois G. Brivet
Received: 15 November 2003 Accepted: 26 February 2004 Published online: 6 April 2004 Springer-Verlag 2004
This work was presented in part, at the 27th Congress of The Socit de Ranimation de Langue Franaise, Paris, France, January 1999, and at the 27th Congress of The European Society of Intensive Care Medicine, Berlin, Germany, October 1999. B. Mgarbane ()) · P. Marchal · F. Jacobs · I. Chary · F. G. Brivet Department of Medical Intensive Care Unit and Medical Emergency, AP-HP Antoine Bclre Hospital, Clamart, France e-mail:
[email protected] Tel.: +33-1-49956491 Fax: +33-1-49956578 A. Marfaing-Koka · O. Belliard Laboratory of Immuno-Hematology, Antoine Bclre Hospital, Clamart, France Present address: B. Mgarbane, Ranimation Mdicale et Toxicologique, Hpital Lariboisire, 2 rue Ambroise Par, 75010 Paris, France
ORIGINAL
Increased diffusion of soluble adhesion molecules in meningitis, severe sepsis and systemic inflammatory response without neurological infection is associated with intrathecal shedding in cases of meningitis
Abstract Objective: Sepsis and systemic inflammatory response syndrome (SIRS) result in the release in plasma of inflammatory cytokines and soluble forms of adhesion molecules in relation to endothelial activation. This study was designed to compare cerebrospinal fluid (CSF) concentrations of adhesion molecules in meningitis and SIRS without neurological infection and to evaluate in meningitis whether they originate from passive diffusion through damaged blood–CSF barrier or from local production. Design: Prospective observational study. Setting: University hospital medical intensive care unit. Patients: Nineteen patients with meningitis and 41 patients with sepsis or SIRS without cerebrospinal infection consecutively admitted to the critical care unit over an 18-month period. Interventions: Soluble forms of adhesion molecules (ICAM-1, VCAM-1, E-selectin) and cytokines (interleukin (IL)-1b and TNFa) were measured in paired CSF and blood samples. Results: Serum concentrations of soluble adhesion molecules and cytokines were increased in the two groups, without significant differences. The CSF concentrations were elevated in both cases, whereas patients with meningitis demonstrated significantly higher CSF con-
centrations of soluble ICAM-1, VCAM-1, E-selectin, and TNF-a (p
