[Studies on low protein C-expression in severe sepsis].
OBJECTIVE
Low concentration of protein C in severe sepsis may be associated with increased morbidity and mortality. The present study was designed to clarify to what extent there are differences in the time course of plasma concentrations of protein C in patients with systemic inflammatory response syndrome or patients with severe sepsis. In addition, the cause of decreased expression of protein C in severe sepsis was examined.


METHODS
32 patients with severe sepsis and 10 patients with systemic inflammatory response syndrome admitted to a surgical intensive care unit were enrolled in the study. While the patients stayed in the intensive care unit protein C plasma concentrations and the clotting factors thrombin-antithrombin-complex and factor VII were determined twice weekly.


RESULTS
Comparing patients with severe sepsis and systemic inflammatory response syndrome there was no significant difference concerning plasma levels of protein C, thrombin-antithrombin-complex and factor VII. In contrast, surviving patients with severe sepsis exhibited significant higher protein C levels compared to non-survivors. In addition, significant lower plasma levels of thrombin-antithrombin-complex were determined in survivors compared to non-survivors. However, factor VII displayed no significant group difference.


CONCLUSIONS
Surviving patients with severe sepsis exhibited higher plasma concentrations of protein C than patients who died during severe sepsis. The lower plasma concentrations of protein C in non-survivors may be caused by an increased turnover of protein C served as endogenous anticoagulant in sepsis associated activation of coagulation.
Manekeller
S
S
Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefässchirurgie, Rheinische Friedrich-Wilhelms-Universität, Bonn.
Hertfelder
H-J
HJ
von Spiegel
T
T
Hering
R
R
Putensen
C
C
Schroeder
S
S
D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D001779:Blood Coagulation Factors / Q000032:analysis; D001780:Blood Coagulation Tests; D005167:Factor VII / Q000032:analysis; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis; D011486:Protein C / Q000032:analysis*; D020151:Protein C Deficiency / Q000150:complications; D018805:Sepsis / Q000097:blood* / Q000401:mortality*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000401:mortality*; D013997:Time Factors
D001779:Blood Coagulation Factors; D011486:Protein C; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D005167:Factor VII; D010447:Peptide Hydrolases