title: Contact system activation in human sepsis - 47kD HK, a marker of sepsis severity?
abstract: OBJECTIVE
  This pilot study seeks to determine whether contact system activation (CSA) occurs in human sepsis patients and to characterise blood levels of the 47kD light chain of high-molecular weight kininogen (47kD HK).
  
  
  METHODS
  Six consecutive patients with clinical suspicion of sepsis were evaluated on days 1, 2, 3 and 6-8 for 47kD HK blood levels expressed in U/ml of whole blood and as percent of total HK. 47kD HK was measured in whole blood by quantitative immunoblot analysis.
  
  
  RESULTS
  On study day 1 or 2, analysis of 47kD HK in U/ml of whole blood identified CSA in 3/6 patients. When 47kD HK levels were expressed as percent of total HK, 4/6 patients were identified with CSA before day 3. The degree of CSA as assayed by the presence of 47kD HK correlated with the severity of the systemic inflammatory syndrome (SIRS), i.e. mean CSA increased progressively from basal levels in healthy controls (0.08 U/ml or 10.4%) to patients without SIRS (0.10 U/ml or 15.1%), to patients with sepsis (0.12 U/ml or 15.0%), and finally to patients in a combined category of severe sepsis and septic shock (0.13 U/ml or 17.4%).
  
  
  CONCLUSIONS
  CSA, defined by increased 47kD HK, occurred early on in the course of sepsis in a subset of sepsis patients. 47kD HK levels, an indicator of bradykinin release, correlated with sepsis severity. Future larger studies will need to evaluate the role of 47kD HK as a biomarker for both prognosis and treatment response in human sepsis..
authors.affiliation: Division of Haematology and Central Haematology Laboratory, Inselspital, Berne, Switzerland. lars.asmis@usz.ch
authors.forename: Lars M
authors.initials: LM
authors.lastname: Asmis
authors.forename: Reto
authors.initials: R
authors.lastname: Asmis
authors.forename: Irmela
authors.initials: I
authors.lastname: Sulzer
authors.forename: Miha
authors.initials: M
authors.lastname: Furlan
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
mesh_terms: D015415:Biomarkers; D001780:Blood Coagulation Tests; D006801:Humans; D015151:Immunoblotting / Q000379:methods*; D019679:Kininogen, High-Molecular-Weight / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D019679:Kininogen, High-Molecular-Weight