title: Plasma secretory leukocyte protease inhibitor in febrile patients.
abstract: OBJECTIVE
  Secretory leukocyte protease inhibitor (SLPI) forms an integral part of the lung's defence, by its antimicrobial activity and by its ability to neutralize serine proteases that are released by granulocytes into the inflammatory exudate. Here, we investigate in febrile patients admitted to hospital whether plasma SLPI can serve as a marker of lung infection.
  
  
  METHODS
  We prospectively determined the SLPI concentration in 152 febrile patients (median 73 [inter-quantile range (IQR): 58-82] year; 50% male) admitted to hospital because of infection of the airways (n = 44) or pneumonia (n = 108; i.e. consolidation on chest X-ray), and in 48 febrile patients (78 [IQR: 71-85] year; 52% male) admitted because of pyelonephritis, as well as afebrile age-matched controls (n = 38). In addition, erythrocyte sedimentation rate (ESR), peripheral blood leukocytes, plasma TNFalpha and IL-10, and parameters of the APACHE-II score were determined on admission.
  
  
  RESULTS
  In febrile patients, SLPI was significantly increased (P < 0.001) compared with afebrile controls (63 [IQR: 50-76] ng/mL): plasma SLPI (113 [IQR: 83-176] ng/mL) was highest (P < 0.005) in patients with pneumonia compared with other groups (88 [IQR: 70-118] ng/mL). Only in patients with pneumonia, bacteremia significantly increased (P < 0.01) SLPI concentrations. Using a radiological classification of pulmonary infiltrates based on their size, it was found that plasma SLPI was proportional to the extent of lung tissue involved: the median concentration increased from 95 [IQR: 74-139] ng/mL in unilateral segmental consolidation up to 271 [IQR: 180-460] ng/mL in bilateral lobar consolidations. In a multivariate analysis, the association between SLPI and extent of consolidation was about two-fold stronger than, and independent of, the association between SLPI and erythrocyte sedimentation rate, TNFalpha, and parameters of the composite APACHE-II score, such as heart rate and blood pressure, that reflect severity of illness.
  
  
  CONCLUSIONS
  SLPI is an indicator of the presence and extent of pneumonia in febrile patients admitted to hospital. In patients with an infection with its primary source located outside the lung, plasma SLPI likely reflects the mucosal response to circulating inflammatory mediators reflecting severity of illness.
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: L A
authors.initials: LA
authors.lastname: Duits
authors.forename: G S
authors.initials: GS
authors.lastname: Tjabringa
authors.forename: N J M
authors.initials: NJ
authors.lastname: Aarts
authors.forename: J W
authors.initials: JW
authors.lastname: van't Wout
authors.forename: P S
authors.initials: PS
authors.lastname: Hiemstra
authors.forename: P H
authors.initials: PH
authors.lastname: Nibbering
authors.forename: J T
authors.initials: JT
authors.lastname: van Dissel
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000503:physiopathology; D016207:Cytokines / Q000097:blood; D005260:Female; D005334:Fever / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D008297:Male; D053491:Proteinase Inhibitory Proteins, Secretory; D011506:Proteins; D011704:Pyelonephritis / Q000097:blood / Q000503:physiopathology; D011956:Receptors, Cell Surface / Q000097:blood*; D012141:Respiratory Tract Infections / Q000097:blood / Q000503:physiopathology; D053481:Secretory Leukocyte Peptidase Inhibitor
chemical_list: D016207:Cytokines; D053491:Proteinase Inhibitory Proteins, Secretory; D011506:Proteins; D011956:Receptors, Cell Surface; C506814:SLPI protein, human; D053481:Secretory Leukocyte Peptidase Inhibitor