Increase of Plasminogen Activator Inhibitor Levels Predicts Outcome of Leukocytopenic Patients with Sepsis
Increase of Plasminogen Activator Inhibitor Levels Predicts Outcome of Leukocytopenic Patients with Sepsis
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DOI：
10.1055/s-0038-1650392
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发表时间：
1996-06
影响因子：
6.7
通讯作者：
R. Mesters;N. Flörke;H. Ostermann;J. Kienast
中科院分区：
文献类型：
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作者：
R. Mesters;N. Flörke;H. Ostermann;J. Kienast
摘要对血液系统恶性肿瘤患者化疗所致的白细胞减少、发病时和败血症病程中纤溶系统的变化进行前瞻性研究，以评价其预后价值。选择这组患者是因为他们发生严重败血症并发症的风险很高，因此可以在败血症或败血症休克发生之前和期间进行一系列前瞻性纤溶变量测试。本研究共收集62例发热感染患者。根据标准诊断标准，其中13名患者进展为严重败血症，另外13名患者发展为感染性休克。在发热开始时，感染性休克患者的纤溶酶原激活物抑制物活性和PAI-1抗原水平较正常基线水平升高，且显著高于严重脓毒症患者(中位数：10.6U/ml比1.3U/ml，p=0.0001；50.0vs5.0 ng/ml，p=0.0002)。感染性休克患者PAI活性和PAI抗原的升高伴随着组织型纤溶酶原激活物抗原和总纤维蛋白(原)降解产物的增加以及α2-抗纤溶酶活性的降低(在发热开始时p 5U/ml预测死亡结果的敏感性为92%，特异性为100%)。因此，白细胞减少症中的感染性休克与纤溶系统的显著激活有关，这可能是血管内皮细胞对炎性损伤的一种反应。此外，PAI活性测定是预后不良的敏感指标。
Summary Variables of the fibrinolytic system were prospectively studied in patients with haematologic malignancies in chemotherapy-induced leukocytopenia at onset and during the course of septicemia to evaluate their prognostic value. This group of patients was chosen because of their high risk of developing severe septic complications, thus allowing serial prospective testing of fibrinolytic variables prior to and during evolving sepsis or septic shock. 62 patients with febrile infectious events were accrued to the study. Of these, 13 patients progressed to severe sepsis and an additional 13 patients to septic shock as defined according to standard diagnostic criteria. At onset of fever, plasminogen activator inhibitor (PAI) activity and PAI-1 antigen levels increased from normal baseline levels and were significantly higher in the group of patients who developed septic shock compared to those with severe sepsis (medians: 10.6 versus 1.3 U/ml, p = 0.0001; 50.0 versus 5.0 ng/ml, p = 0.0002). The increase in PAI activity and antigen in septic shock was accompanied by an increase in tissue-type plasminogen activator antigen and total fibrin(ogen) degradation products and a decrease in alpha2-antiplasmin activity (p 5 U/ml at onset of fever predicted a lethal outcome with a sensitivity of 92% and a specificity of 100%. Thus, septic shock in leukocytopenia is associated with significant activation of the fibrinolytic system presumably as a response of the vascular endothelium to inflammatory injury. Furthermore, PAI activity measurements are sensitive markers of an unfavourable prognosis.