Elevated plasma tissue-type plasminogen activator (t-PA) and soluble thrombomodulin in patients suffering from severe acute respiratory syndrome (SARS) as a possible index for prognosis and treatment strategy.
OBJECTIVE
To detect the presence of endothelial injury in patients with severe acute respiratory syndrome (SARS) via enhanced levels of tissue-type plasminogen activator (t-PA) and soluble thrombomodulin (sTM).


METHODS
Case patients were from Xuanwu Hospital (Capital University of Medical Sciences, Beijing, China), and all of them met clinical criteria for SARS. Healthy controls were some of the hospital employees. Endothelial injury bio-markers tPA and sTM were detected by commercial ELISA-methods.


RESULTS
Classic plasma markers of endothelial injury, tPA and sTM significantly elevated in SARS patients in comparison to controls [t-PA: 1.48 +/- 0.16 nmol/L versus 0.25 +/- 0.03 nmol/L (P<0.0001), and sTM: 0.26 +/- 0.06 nmol/L versus 0.14 +/- 0.02 nmol/L (P<0.05)]. The only patient who died had extremely high levels of these endothelial injury markers (t-PA: 2.77 nmol/L and sTM: 1.01 nmol/L). The likelihood ratio analysis indicated the excellent discriminating power for SARS at the optimal cut-point of 0.49 nmol/L for tPA and 0.20 nmol/L for sTM, respectively. Significant numerical correlations were found among these endothelial injury markers in SARS patients. The numerical coefficient of correlation Pearson r between t-PA and sTM was 0.5867 (P<0.05).


CONCLUSIONS
Increased plasma concentrations of tPA and sTM in patients with SARS suggest the possibility of endothelial injury. SARS patients might need anticoagulant therapy or fibrinolytic therapy in order to reverse intraalveolar coagulation, microthrombi formation, alveolar and interstitial fibrin deposition. It may not only provide a useful treatment and prognostic index but also allow a further understanding of the pathological condition of the disease.
Liu
Zhong-Hua
ZH
School of Medicine, Xi'an Jiaotong University, Shaanxi, China.
Wei
Ran
R
Wu
Ya-Ping
YP
Lisman
Ton
T
Wang
Zeng-Xian
ZX
Han
Ji-Ju
JJ
Ren
Dao-Ling
DL
Chen
Bin
B
Xia
Zuo-Li
ZL
Chen
Biao
B
Zhu
Zhen
Z
Zhang
Yan
Y
Cui
Xing
X
Hu
Hai-Tao
HT
de Groot
Philip G
PG
Xu
Wen-Bo
WB
D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D045169:Severe Acute Respiratory Syndrome / Q000097:blood*; D018180:Thrombomodulin / Q000097:blood*; D010959:Tissue Plasminogen Activator / Q000097:blood*
D015415:Biomarkers; D018180:Thrombomodulin; D010959:Tissue Plasminogen Activator