Biochemical pathways of acute lung injury.
Complement fragments (C3, C3d, C5a), thromboxane B2 (TxB2), 6-keto-PGF1 alpha and immunoreactive trypsin (IRT) were measured in 98 patients at risk of developing the adult respiratory distress syndrome (ARDS): 53 multiple trauma, 28 abdominal surgery and 17 acute pancreatitis. Sixty-five of these patients developed ARDS: 30 multiple trauma, 19 abdominal surgery and 16 acute pancreatitis patients. Forty of the 65 ARDS patients and 9 out of the 33 non-ARDS patients died. Mean value of the C3d to C3 ratio was abnormal in both ARDS and non-ARDS patients. C5a-like activity was detected in 70 out of the 98 patients (49 ARDS and 22 non-ARDS patients). TxB2 abnormal values (greater than 100 pg . ml-1) were found in 70% of the patients, especially when sepsis occurred. No correlation could be made between abnormal 6-keto PGF1 alpha values and ARDS or sepsis. The mean peak IRT value was 675 micrograms . 1(-1) for ARDS patients and 274 micrograms . 1(-1) for non-ARDS patients (p less than 0.05). A firm correlation was also measured between IRT and sepsis (p less than 0.01). C5a-like activity was regularly detected soon after injury, while TxB2 and IRT tend to appear later in patients developing ARDS. Neither C3d/C3, nor C5a-like activity, nor TxB2, nor IRT are specific markers of ARDS, since they also appeared in severely ill patients who did not develop ARDS.
D015121:6-Ketoprostaglandin F1 alpha / Q000097:blood; D000005:Abdomen; D003176:Complement C3 / Q000378:metabolism; D015933:Complement C3d; D003182:Complement C5 / Q000378:metabolism; D015936:Complement C5a; D006801:Humans; D055370:Lung Injury; D010195:Pancreatitis / Q000097:blood / Q000150:complications; D012128:Respiratory Distress Syndrome / Q000097:blood / Q000209:etiology / Q000378:metabolism*; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D013929:Thromboxane B2 / Q000097:blood; D014357:Trypsin / Q000097:blood; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications
D003176:Complement C3; D003182:Complement C5; D013929:Thromboxane B2; D015121:6-Ketoprostaglandin F1 alpha; D015933:Complement C3d; D015936:Complement C5a; D014357:Trypsin