title: Study of platelet-activating factor acetylhydrolase in the perioperative period of patients undergoing cardiac surgery.
abstract: After operations with cardiopulmonary bypass, patients often show early symptoms of the systemic inflammatory response syndrome (SIRS). Potential mediators of SIRS include the platelet-activating factor (PAF), which has been linked to septic shock and multiple organ dysfunction. We studied the effect of cardiac surgery on PAF acetylhydrolase, the PAF-degrading plasma enzyme, as well as the relationship between the enzyme and the postoperative state of the patients. PAF acetylhydrolase activity decreased by 38+/-8% after instituting cardiopulmonary bypass because of plasma dilution and returned to near-preoperative levels within 6 h postsurgery. After that, enzyme levels decreased again, resulting in a 24+/-12% reduction until at least 3 days postsurgery. Patients in poor postoperative condition (Acute Physiology Score >9) had a lower preoperative PAF acetylhydrolase activity than did normal patients (12+/-4 vs. 17+/-4 nmol min(-1) mL(-1); p < .05). Likewise, patients who developed postoperative SIRS had a lower preoperative PAF acetylhydrolase activity than did patients without SIRS (12+/-3 vs. 17+/-4 nmol min(-1) mL(-1); p < .05). The data suggest that PAF acetylhydrolase deficiency is among the factors associated with postoperative distress after cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Therapy, University Hospital Charité, Humboldt University, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schlame
authors.forename: A B
authors.initials: AB
authors.lastname: Schmid
authors.forename: R
authors.initials: R
authors.lastname: Haupt
authors.forename: B
authors.initials: B
authors.lastname: Rüstow
authors.forename: W J
authors.initials: WJ
authors.lastname: Kox
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001054:Apolipoproteins A / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010741:Phospholipases A / Q000097:blood*; D011184:Postoperative Period; D012016:Reference Values; D012044:Regression Analysis
chemical_list: D001054:Apolipoproteins A; D001055:Apolipoproteins B; D002784:Cholesterol; D010741:Phospholipases A; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase