title: Hyperglycemia is associated with lower levels of urokinase-type plasminogen activator and urokinase-type plasminogen activator receptor in wound fluid.
abstract: OBJECTIVE
  Wounds in patients with hyperglycemia show impaired healing. Plasminogen activation is crucial in several overlapping phases of wound healing process. In this study, we aimed i) to compare acute wound fluid in patients with hyperglycemia and normoglycemia, ii) to focus on the elements of plasminogen activation in the wound fluid, and iii) to determine if the acute wound fluid characteristics are associated with surgical site infections.
  
  
  METHODS
  In a cohort of 54 patients, a closed suction drain was placed in the wound above the anterior abdominal wall fascia under the skin in order to collect postoperative acute wound fluid samples for 3 following days after colorectal surgery. Patients were classified as normoglycemic (n=25) or hyperglycemic (n=29; 17 with type 2 diabetes and 12 with stress induced hyperglycemia). Surgical site infection was defined according to the Centers for Disease Control criteria. The levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAr), plasminogen activator inhibitor-1 (PAI-1), interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), and fibroblast growth factor-1 (FGF-1) were measured in the wound fluid.
  
  
  RESULTS
  Compared to normoglycemic subjects, patients with hyperglycemia had significantly lower levels of uPA and uPAr in the wound fluid despite similar or even higher circulating levels. There was no significant difference in IL-1β, TNF-α, PAI-1 and FGF-1 levels. In the whole study population, the wound fluid levels of uPA and uPAr were negatively correlated with circulating glucose levels. No difference was detected in the wound fluid characteristics of patients with and without surgical site infection.
  
  
  CONCLUSIONS
  Patients with hyperglycemia exhibit decreased levels of uPA and uPAr in the wound fluid, suggesting a local failure in plasminogen activation at the wound site.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey. Electronic address: barisakincimd@gmail.com.
authors.forename: Baris
authors.initials: B
authors.lastname: Akinci
authors.affiliation: Division of Colorectal Surgery, Department of Surgery, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Terzi
authors.affiliation: Division of Hematology, Department of Internal Medicine, Izmir, Turkey.
authors.forename: Gokmen
authors.initials: G
authors.lastname: Sevindik
authors.affiliation: Division of Hematology, Department of Internal Medicine, Izmir, Turkey.
authors.forename: Faize
authors.initials: F
authors.lastname: Yuksel
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Ulku Aybuke
authors.initials: UA
authors.lastname: Tunc
authors.affiliation: Division of Hematology, Department of Internal Medicine, Izmir, Turkey.
authors.forename: Sunay
authors.initials: S
authors.lastname: Tunali
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Sena
authors.initials: S
authors.lastname: Yesil
mesh_terms: D000368:Aged; D001826:Body Fluids / Q000378:metabolism*; D003107:Colorectal Surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000601:surgery; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055293:Receptors, Urokinase Plasminogen Activator / Q000378:metabolism*; D012867:Skin / Q000378:metabolism / Q000473:pathology; D013530:Surgical Wound Infection / Q000150:complications / Q000378:metabolism; D014568:Urokinase-Type Plasminogen Activator / Q000378:metabolism*; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000378:metabolism* / Q000473:pathology
chemical_list: D055293:Receptors, Urokinase Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator
keywords: Diabetes; Hyperglycemia; Plasminogen activation; Wound fluid; Wound healing