Complement activation in emergency department patients with severe sepsis.
Complement activation in emergency department patients with severe sepsis.
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急诊科严重脓毒症患者的补体激活。
DOI：
10.1111/j.1553-2712.2010.00713.x
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Jones,AlanE
中科院分区：
文献类型：
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作者：
Younger,JohnG;Bracho,DavidO;Chung-Esaki,HangyulM;Lee,Moonseok;Rana,GurpreetK;Sen,Ananda;Jones,AlanE
目的：本研究评估了社区获得性脓毒症患者在急诊科（艾德）就诊和24小时定量复苏后补体激活的程度和机制。方法：在三级护理ED就诊的个体中，对严重脓毒症患者和健康对照进行了前瞻性初步研究。对所有患者进行复苏，包括抗生素和治疗，以使中心静脉压和平均动脉压（MAP）和中心静脉氧合正常化。 在患者就诊时和24小时后测定血清因子Bb（旁路途径）、C4 d（经典和甘露糖结合凝集素[MBL]途径）、C3、C3 a和C5 a水平。与志愿者相比，脓毒症患者中测量的所有蛋白质均异常升高（C4d 3.5倍;因子Bb 6.1倍; C3 0.8倍; C3 a 11.6倍; C5 a 1.8倍）。C5 a的升高与旁路途径激活的相关性最强。令人惊讶的是，注意到疾病严重程度（通过序贯器官衰竭评估[SOFA]评分）与就诊时的C5 a水平之间存在轻微但显著的负相关。平均而言，24小时的结构性复苏不会影响任何研究的介质。结论：社区获得性脓毒症患者在出现时有广泛的补体激活，特别是旁路途径，24小时的积极复苏不会显著逆转。学术急诊医学2010; 17：353-359 © 2010由学术急诊医学学会
Objectives:This study assessed the extent and mechanism of complement activation in community‐acquired sepsis at presentation to the emergency department (ED) and following 24 hours of quantitative resuscitation.Methods:A prospective pilot study of patients with severe sepsis and healthy controls was conducted among individuals presenting to a tertiary care ED. Resuscitation, including antibiotics and therapies to normalize central venous and mean arterial pressure (MAP) and central venous oxygenation, was performed on all patients. Serum levels of Factor Bb (alternative pathway), C4d (classical and mannose‐binding lectin [MBL] pathway), C3, C3a, and C5a were determined at presentation and 24 hours later among patients.Results:Twenty patients and 10 healthy volunteer controls were enrolled. Compared to volunteers, all proteins measured were abnormally higher among septic patients (C4d 3.5‐fold; Factor Bb 6.1‐fold; C3 0.8‐fold; C3a 11.6‐fold; C5a 1.8‐fold). Elevations in C5a were most strongly correlated with alternative pathway activation. Surprisingly, a slight but significant inverse relationship between illness severity (by sequential organ failure assessment [SOFA] score) and C5a levels at presentation was noted. Twenty‐four hours of structured resuscitation did not, on average, affect any of the mediators studied.Conclusions:Patients with community‐acquired sepsis have extensive complement activation, particularly of the alternative pathway, at the time of presentation that was not significantly reversed by 24 hours of aggressive resuscitation.ACADEMIC EMERGENCY MEDICINE 2010; 17:353–359 © 2010 by the Society for Academic Emergency Medicine