Plasminogen: an important hemostatic parameter in septic patients.
BACKGROUND
Previously we observed in some but not all septic patients a low plasma concentration of plasminogen.


OBJECTIVE
To investigate prospectively whether plasma levels of plasminogen or the ratio of plasminogen to alpha-2-antiplasmin have a prognostic value for survival from sepsis and to study the variation of other hemostatic parameters during septicemia.


METHODS
The study population consisted of 45 consecutive patients with septicemia, 15 non-septic patients from the same intensive care unit and 30 healthy volunteers.


RESULTS
Plasminogen concentrations were significantly lower (p < 0.001) in plasma of septic patients (median 0,62 IU/ml range: 0.15-1,06) than in plasma of healthy controls (median 1.00 IU/ml, range: 0.75-1.10) or of non-septic intensive care patients (median 1.00 IU/ml, range: 0.82-1.08). Among the other parameters tested, plasminogen activator inhibitor (PAI-1) antigen concentration and PAI activity were similar in septic and non-septic intensive care patients, but higher than in healthy controls. Concentrations of elastase-alpha-1-protease inhibitor or of thrombin-antithrombin complexes were higher in septic patients than in non-septic intensive care patients or healthy controls. A degraded form of plasminogen of 38 kDa was detected by Western blot analysis in the plasma of septic patients, but not in plasma of non-septic intensive care patients or controls. Plasminogen alone or the ratio of plasminogen to antiplasmin were good markers for survival from septicemia. E.g. for plasminogen at a cut off of 0.65 IU/ml, sensitivity was 90.5% and specificity 66.7%, whereas for the ratio of plasminogen over antiplasmin at a cut off ratio of 0,65 IU/ml, sensitivity was 95.2% and specificity 70.8%.


CONCLUSIONS
Plasminogen or the ratio of plasminogen to antiplasmin are sensitive markers for survival in patients with septicemia.
Duboscq
C
C
Dpto. de Química Biológica, Facultad de Clencias Exactas y Naturales, Universidad de Buenos Aires, Argentina.
Quintana
I
I
Bassilotta
E
E
Bergonzelli
G E
GE
Porterie
P
P
Sassetti
B
B
Haedo
A S
AS
Wainsztein
N
N
Kruithof
E K
EK
Kordich
L
L
D000328:Adult; D000368:Aged; D006487:Hemostasis; D006801:Humans; D008875:Middle Aged; D010958:Plasminogen / Q000032:analysis*; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000503:physiopathology; D000979:alpha-2-Antiplasmin / Q000032:analysis*
D000979:alpha-2-Antiplasmin; D010958:Plasminogen