Objective To determine if serum levels of endothelial adhesion molecules were associated with the development of multiple organ failure (MOF) and in-hospital mortality in adult patients with severe sepsis. Design This study was a secondary data analysis of a prospective cohort study. Setting Patients were admitted to two tertiary intensive care units in San Antonio, TX, between 2007 and 2012. Patients Patients with severe sepsis at the time of intensive care unit (ICU) admission were enrolled. Inclusion criteria were consistent with previously published criteria for severe sepsis or septic shock in adults. Exclusion criteria included immunosuppressive medications or conditions. Interventions None. Measurements Baseline serum levels of the following endothelial cell adhesion molecules were measured within the first 72 hours of ICU admission: Intracellular Adhesion Molecule 1 (ICAM-1), Vascular Cell Adhesion Molecule-1 (VCAM-1), and Vascular Endothelial Growth Factor (VEGF). The primary and secondary outcomes were development of MOF (≥2 organ dysfunction) and in-hospital mortality, respectively. Main results Forty-eight patients were enrolled in this study, of which 29 (60%) developed MOF. Patients that developed MOF had higher levels of VCAM-1 (p=0.01) and ICAM-1 (p=0.01), but not VEGF (p=0.70) compared with patients without MOF (single organ failure only). The area under the curve (AUC) to predict MOF according to VCAM-1, ICAM-1 and VEGF was 0.71, 0.73, and 0.54, respectively. Only increased VCAM-1 levels were associated with in-hospital mortality (p=0.03). These associations were maintained even after adjusting for APACHE and SOFA scores using logistic regression. Conclusions High levels of serum ICAM-1 was associated with the development of MOF. High levels of VCAM-1 was associated with both MOF and in-hospital mortality.

High endocan levels are associated with the need for mechanical ventilation among patients with severe sepsis To the Editor: Sepsis affects more than 750 000 Americans each year, with a mortality rate close to 30% [1]. A significant amount of resources has been put into improving our understanding of sepsis and developing new therapies. A push for early sepsis recognition and subsequent timely treatment has led to an interest in inflammatory biomarkers to identify sepsis and its severity [2]. Respiratory dysfunction occurs in up to 81% of cases and a significant proportion requires ventilatory support [1]. Studies have looked at a variety of biomarkers, from inflammatory cytokines such as interleukin (IL)-6 to endothelial proteins like intercellular adhesion molecule-1, to identify patients at greatest risk of developing respiratory compromise [3]. Endocan is a 50-kDa dermatan sulfate proteoglycan initially discovered in lung and kidney endothelial cells [4] and later in the vasculature and tumour cells [5]. Inflammatory mediators stimulate endocan expression and elevated levels have been demonstrated in septic pneumonia [6] and in community-acquired pneumonia patients [7]. Endocan also has been shown to be a marker for the severity of acute respiratory distress syndrome (ARDS)[3], which may be explained by an incompletely described pathway involving hypoxia inducible factor (HIF)-1 stimulating endocan expression [8]. Understanding the relationship between endocan and respiratory failure can help predict the severity of disease, the need for more aggressive management and the development of new therapies for management of hypoxia in various disease states. Therefore, the primary objective of our study is to determine the association between endocan and the need for mechanical ventilation secondary to sepsis-related respiratory failure during intensive care unit (ICU) admission in septic patients.

Pasteurella multocida is a small Gram-negative organism that usually causes a localized infection after exposure to cat or dog scratches, bites, or licking wounds. Invasive infections, such as bacteremia and endocarditis, are very rare yet serious conditions that are associated with high morbidity and mortality, particularly in patients with major comorbidities. Here, we report a case of a 47-year-old male who presented to the hospital with altered mental status two weeks after a fall and was found to have a subarachnoid hemorrhage. Further workup revealed Pasteurella multocida bacteremia and infective endocarditis. The patient had a complex hospital course with septic shock and acute congestive heart failure with poor clinical outcomes. A comprehensive review of the literature of all reported cases of definite Pasteurella endocarditis follows.

Low dose computed tomography (LDCT) is the standard of care for lung cancer screening in the United States (US). LDCT has a sensitivity of 93.8% but its specificity of 73.4% leads to potentially harmful follow-up procedures in patients without lung cancer. Thus, there is a need for additional assays with high accuracy that can be used as an adjunct to LDCT to diagnose lung cancer. Sputum is a biological fluid that can be obtained non-invasively and can be dissociated to release its cellular contents, providing a snapshot of the lung environment. We obtained sputum from current and former smokers with a 30+ pack-year smoking history and who were either confirmed to have lung cancer or at high risk of developing the disease. Dissociated sputum cells were counted, viability determined, and labeled with a panel of markers to separate leukocytes from non-leukocytes. After excluding debris and dead cells, including squamous epithelial cells, we identified reproducible population signatures and confirmed the samples’ lung origin. In addition to leukocyte and epithelial-specific fluorescent antibodies, we used the highly fluorescent meso-tetra(4-carboxyphenyl) porphyrin (TCPP), known to preferentially stain cancer (associated) cells. We looked for differences in cell characteristics, population size and fluorescence intensity that could be useful in distinguishing cancer samples from high-risk samples. We present our data demonstrating the feasibility of a flow cytometry platform to analyze sputum in a high-throughput and standardized matter for the diagnosis of lung cancer.