Increased levels of soluble adhesion molecules, E-selectin and P-selectin, in patients with infective endocarditis and embolic events

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Abstract
Aims Inflammation-induced procoagulant changes and endothelial cell activation appear to play an important role in thromboembolic complications of infective endocarditis. Hence, the aim of this study was to compare the plasma levels of soluble adhesion molecules E- and P-selectin in infective endocarditis patients with and without embolic events, and healthy subjects. Methods and Results The study group consisted of 76 consecutive patients (mean age=26 years old, range from 8 to 64 years) with definite infective endocarditis according to the Duke criteria. Thirteen of the patients (17·1%) had embolic events. Transoesophageal echocardiographic examinations were performed on all patients within 3 days of initiation of antimicrobial therapy. Although there was a trend towards a higher rate of vegetations detected in those with embolic events than in those without, this did not reach statistical significance (84·6% vs 80·9%, P>0·05). Significantly larger vegetations were observed in patients with embolic events as compared to those without embolic events (1·4cm vs 1·0cm,P =0·03). The mean plasma concentrations of P-selectin were elevated in patients with embolic events as compared to both patients without embolic events and control subjects (58·69±7·49ng.ml−1vs 29·65±5·69ng.ml−1, P=−1vs 25·82±5·38ng.ml−1, P−1vs 42·84±8·77ng.ml−1, P−1vs 34·23±5·92ng.ml−1,P Conclusion Determination of these membrane activation molecules may provide useful markers with which to identify patients at high thromboembolic risk from infective endocarditis.

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