Granulocyte elastase, tumor necrosis factor-alpha and urokinase levels as prognostic markers in severe infection.
We have examined the prognostic value of the levels in the blood of granulocyte elastase-alpha 1-proteinase inhibitor (E-alpha 1-PI) complex, tumor necrosis factor-alpha (TNF-alpha) and urokinase-type plasminogen activator (u-PA) in 35 patients with severe infection upon admission to an Intensive Care Unit. Fourteen patients died. No differences for E-alpha 1-PI complex were found between survivors and nonsurvivors, but in all patients the levels on admission were eight-fold higher than the reference value. TNF-alpha levels, measured by immunoassay, on admission were four times higher in the nonsurvivors than in the survivors (p = 0.0003) and correlated with the severity of the disease (APACHE II score, r = 0.43, p less than 0.05). TNF-alpha was not detectable by bioassay. Total u-PA antigen (u-PA Ag), plasmin-activatable single-chain u-PA (scu-PA) and inactive, nonactivatable u-PA (u-PA#) were on admission all two-fold higher in the nonsurvivors (p = 0.0006, 0.003 and 0.0003, respectively), while normal in the survivors. In both, survivors and nonsurvivors, the ratio between scu-PA and u-PA Ag was significantly decreased (p less than 0.001, compared to a reference group of healthy volunteers), indicative for enhanced conversion of scu-PA to active two-chain u-PA (tcu-PA) and inactive u-PA# during severe infectious disease. tcu-PA was detected in nine of the 35 patients, while virtually undetectable in controls. scu-PA correlated with the Child-Pugh score on admission (r = 0.42, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Philippé
J
J
Department of Clinical Chemistry, University Hospital of Gent, Belgium.
Dooijewaard
G
G
Offner
F
F
Turion
P
P
Baele
G
G
Leroux-Roels
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000941:Antigens / Q000097:blood; D001424:Bacterial Infections / Q000097:blood* / Q000201:enzymology; D015415:Biomarkers / Q000097:blood; D005260:Female; D006098:Granulocytes / Q000201:enzymology*; D006801:Humans; D007118:Immunoassay; D008297:Male; D008875:Middle Aged; D010196:Pancreatic Elastase / Q000097:blood* / Q000737:chemistry; D011379:Prognosis; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*; D014568:Urokinase-Type Plasminogen Activator / Q000097:blood* / Q000276:immunology; D000515:alpha 1-Antitrypsin / Q000737:chemistry
D000941:Antigens; D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D000515:alpha 1-Antitrypsin; D010196:Pancreatic Elastase; D014568:Urokinase-Type Plasminogen Activator