A multicenter study of phospholipase A2 in patients in intensive care units.
BACKGROUND
Multiple organ failure (MOF) is becoming the most common cause of death in patients in surgical intensive care units. In this respect, a multicenter study in four different groups of patients in surgical intensive care units was done to evaluate the role of phospholipase A2 (PLA2) in comparison with C-reactive protein (CRP) and polymorphonuclear (PMN) elastase.


METHODS
A total of 223 patients entered the study: 73 patients with multiple injuries, 46 patients with diffuse peritonitis, 52 patients with sepsis, and 52 patients in a control group who were at a higher risk for postoperative sepsis after defined surgical interventions. The patients underwent a daily monitoring of PLA2, CRP, and PMN elastase for seven days.


RESULTS
Phospholipase A2 activity remained within the normal range in patients with multiple injuries and patients in the control group, indicating that this parameter is not influenced by the postaggression metabolism. In contrast, in patients with peritonitis, high PLA2 values were found from the beginning. The efficiency for predicting a lethal MOF was 85 percent for PLA2 (cut-off 80 U/L) in patients if determined at the day of operation. A comparably favorable efficiency (84 percent) was demonstrated for PMN elastase in patients with multiple injuries (cut-off 205 micrograms/L) measured at day one.


CONCLUSIONS
These efficiency rates of PLA2 in peritonitis and PMN elastase in multiple injuries were comparable or even better than multifactorial scoring systems used in the study. C-reactive protein did not contribute to an early estimation of the prognosis in all groups analyzed. Therefore, the measurement of PLA2 in patients with diffuse peritonitis and PMN elastase in patients with multiple injuries, as single parameters, is recommended to estimate the individual risk for the occurrence of lethal MOF.
Uhl
W
W
Department of Visceral and Transplantation Surgery, University of Berne, Switzerland.
Beger
H G
HG
Hoffmann
G
G
Hanisch
E
E
Schild
A
A
Waydhas
C
C
Entholzner
E
E
Müller
K
K
Kellermann
W
W
Vogeser
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D003422:Critical Care; D005260:Female; D005544:Forecasting; D006801:Humans; D019272:Leukocyte Elastase; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology*; D009104:Multiple Trauma / Q000097:blood; D010196:Pancreatic Elastase / Q000097:blood*; D010538:Peritonitis / Q000097:blood; D010741:Phospholipases A / Q000097:blood*; D054467:Phospholipases A2; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors
D002097:C-Reactive Protein; D010741:Phospholipases A; D054467:Phospholipases A2; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase