Neutrophil elastase and systemic inflammatory response syndrome in the initiation and development of acute lung injury among critically ill patients.
Critically ill patients are commonly associated with systemic inflammatory response syndrome (SIRS) and are at a greater risk of developing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Under these conditions, large amounts of various cytokines are produced, which either directly or indirectly induce tissue injury and finally organ dysfunctions, through the activation of neutrophils and as a result of release of cytotoxic molecules, especially neutrophil elastase (NE). In the present study, we determined plasma neutrophil elastase-alpha-1 antitrypsin complex (NE-AT) and elastase digests of cross-linked fibrin (e-XDP) in critically ill patients to elucidate the significance of NE in the initiation and progression of ALI and ARDS in the presence or absence of SIRS. We found significantly increased levels of plasma NE-AT in the patients with ARDS, especially when the definition of SIRS was met. Among ALI/ARDS groups, plasma NE-AT, but not e-XDP, correlated significantly with the decrease in PaO(2)/FIO(2) ratio and the duration of ALI/ARDS. Furthermore, NE-AT, but not e-XDP, significantly increased in subgroups whose PaO(2)/FIO(2) ratio decreased by more than 20%. Such correlations and differences between the subgroups were not observed in the non-ALI patients. From these results, we speculate that NE-AT, but not e-XDP, may be predictive of progressive lung injury in the early stage of ALI and ARDS.
Fujishima
Seitaro
S
Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. fujishim@sc.itc.keio.ac.jp
Morisaki
Hiroshi
H
Ishizaka
Akitoshi
A
Kotake
Yoshifumi
Y
Miyaki
Masaru
M
Yoh
Kikuo
K
Sekine
Kazuhiko
K
Sasaki
Junichi
J
Tasaka
Sadatomo
S
Hasegawa
Naoki
N
Kawai
Yohko
Y
Takeda
Junzo
J
Aikawa
Naoki
N
D016638:Critical Illness; D005260:Female; D005337:Fibrin / Q000032:analysis; D006801:Humans; D019272:Leukocyte Elastase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011485:Protein Binding; D012128:Respiratory Distress Syndrome / Q000201:enzymology / Q000209:etiology* / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications*; D000515:alpha 1-Antitrypsin / Q000097:blood
D000515:alpha 1-Antitrypsin; D005337:Fibrin; D019272:Leukocyte Elastase