title: Protein C, protein S and C4b-binding protein in severe infection and septic shock.
abstract: We measured concentrations of the natural anticoagulant protein C; its cofactor, protein S; and the carrier protein C4b-binding protein (C4BP), in 24 patients with severe infection and 13 with septic shock. Decreased antithrombin III levels were found in 16 of 24 infection patients and all shock patients; high thrombin-antithrombin (TAT) complexes were present in 16 of 24 infection and 12 of 13 shock patients. Protein C concentrations were significantly reduced compared to healthy blood donors, to 60 +/- 14% (infection) and 47 +/- 20% (septic shock) (mean +/- 1 SD). Total protein S levels were not reduced (119 +/- 36.7 and 88 +/- 20.0%, normal value 96 +/- 15%). Free protein S was also normal (27 +/- 9.4 and 30 +/- 8.7%, normal value 29 +/- 9%). The percentage free of total protein S was normal in shock patients (35 +/- 8.5%), but significantly reduced in patients without shock (23 +/- 5.3%). C4BP was significantly higher than normal in the latter group (135 +/- 43%), but not in the shock group (118 +/- 40%), possibly due to increased consumption. Thus, no deficiency of total or free protein S was found in these patients, who had evidence of activated coagulation but no clinical DIC.
authors.affiliation: Department of Anaesthesiology, University Hospital, Linköping, Sweden.
authors.forename: J F
authors.initials: JF
authors.lastname: Hesselvik
authors.forename: J
authors.initials: J
authors.lastname: Malm
authors.forename: B
authors.initials: B
authors.lastname: Dahlbäck
authors.forename: M
authors.initials: M
authors.lastname: Blombäck
mesh_terms: D001424:Bacterial Infections / Q000097:blood*; D001798:Blood Proteins / Q000378:metabolism*; D002352:Carrier Proteins / Q000097:blood; D003169:Complement Inactivator Proteins; D005165:Factor V / Q000378:metabolism; D005167:Factor VII / Q000378:metabolism; D006023:Glycoproteins / Q000097:blood; D006801:Humans; D011486:Protein C / Q000378:metabolism; D017293:Protein S; D011951:Receptors, Complement / Q000097:blood; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood*
chemical_list: D001798:Blood Proteins; D002352:Carrier Proteins; D003169:Complement Inactivator Proteins; D006023:Glycoproteins; D011486:Protein C; D017293:Protein S; D011951:Receptors, Complement; D005165:Factor V; D005167:Factor VII