Early procoagulant shift in the bronchoalveolar compartment of patients with secondary peritonitis.
BACKGROUND
In acute respiratory distress syndrome or pneumonia, a procoagulant shift is observed in bronchoalveolar lavage fluid (BALF). The effect of a primarily extrapulmonary infection on coagulation and fibrinolysis in the pulmonary compartment is unclear.


METHODS
In 35 patients, 87 bronchoalveolar lavages were performed on the day of operation for secondary peritonitis (day 0) and on days 2 and 3 after surgery. Two noninfectious control groups were included: subjects undergoing bronchoalveolar lavage after elective surgery (n=8) and those undergoing long-term mechanical ventilation (n=10).


RESULTS
In BALF from patients with peritonitis, a tissue factor (TF)/factor VIIa-mediated activation of coagulation was shown (high levels of thrombin-antithrombin complexes). Levels of fibrinolysis activators decreased rapidly after day 0, whereas levels of inhibitors increased. The net effect was reduced fibrinolysis (plasminogen activator activity). The sequential comparison of plasma levels of TF pathway inhibitor showed higher levels in patients who died (28-day mortality; P<.001). Sequential levels of TF in BALF were higher in patients with low PaO2 : FiO2 ratios (<200; P=.039). Differences between patients and control subjects were more pronounced in BALF than in plasma.


CONCLUSIONS
Secondary peritonitis induces an early activation of the coagulation and inhibition of fibrinolysis in the systemic and bronchoalveolar compartments, possibly via a compartmentalized response. This imbalance may be associated with reduced oxygen delivery and an adverse outcome in secondary peritonitis.
van Till
J W Olivier
JW
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Levi
Marcel
M
Bresser
Paul
P
Schultz
Marcus J
MJ
Gouma
Dirk J
DJ
Boermeester
Marja A
MA
D000368:Aged; D001777:Blood Coagulation / Q000502:physiology*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D015942:Factor VIIa / Q000378:metabolism; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D007249:Inflammation; D007962:Leukocytes / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology; D010538:Peritonitis / Q000150:complications* / Q000401:mortality; D018805:Sepsis / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000378:metabolism; D014568:Urokinase-Type Plasminogen Activator / Q000378:metabolism
D015942:Factor VIIa; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator