title: The APC-PCI complex concentration predicts outcome of aortic surgery.
abstract: BACKGROUND
  Coagulation activation may be related to complications during surgery for abdominal aortic aneurysm. The complex formed between activated protein C (APC) and the serpin, protein C inhibitor (PCI), is a sensitive indicator of the activation of blood coagulation. The purpose of the study was to establish whether the APC-PCI complex can provide information useful for the assessment of outcome after aortic surgery.
  
  
  METHODS
  In 38 patients, the APC-PCI complex was initially determined every 6 h and daily from day three. Protein C, antithrombin, global haemostatic tests, and clinical scores were investigated. Length of stay at the intensive care unit (ICU) and hospital, and vital status up to two years were recorded.
  
  
  RESULTS
  The median APC-PCI complex concentration in samples drawn 0-6 h after surgery was more than 20-fold higher than the upper limit of the reference interval. The level then declined rapidly, but remained elevated during the first two days. In patients with higher initial APC-PCI complex concentrations, Sequential Organ Failure Assessment (SOFA) scores were higher, the ICU stay was longer, and survival up to two years was lower. Patients who did not survive the ICU care had higher APC-PCI complex levels at 6-12 h and 12-18 h.
  
  
  CONCLUSIONS
  High concentrations of the APC-PCI complex within 6-18 h after the aortic surgery predict a sinister outcome. The results suggest that the APC-PCI complex is indicative of the severity of the disease.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Lund University, Malmö University Hospital, SE-205 02 Malmö, Sweden. gunnar.a.nilsson@skane.se
authors.forename: Gunnar
authors.initials: G
authors.lastname: Nilsson
authors.forename: Karin
authors.initials: K
authors.lastname: Strandberg
authors.forename: Jan
authors.initials: J
authors.lastname: Astermark
authors.forename: Einar
authors.initials: E
authors.lastname: Vernersson
authors.forename: Johan
authors.initials: J
authors.lastname: Stenflo
authors.forename: Erik
authors.initials: E
authors.lastname: Berntorp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood* / Q000401:mortality / Q000601:surgery*; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D046912:Multiprotein Complexes / Q000097:blood / Q000737:chemistry; D011446:Prospective Studies; D011486:Protein C / Q000737:chemistry / Q000378:metabolism*; D018046:Protein C Inhibitor / Q000097:blood* / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D046912:Multiprotein Complexes; D011486:Protein C; D018046:Protein C Inhibitor