Immunomodulation of AT III in septic disease

Introduction

Antithrombin III is a physiological inhibitor of thrombin, a central procoagulatory factor with pleiotropic activities. Decompensated disseminated intravascular coagulation in septic patients is associated with a rapid consumption of AT III. Therefore the anti-inflammatory effects of AT III is a main point of interest in the pathway of sepsis. To determine whether AT III concentration has beneficial effects on the severity of immunological function in sepsis, the present study investigated the association between AT III and the DR-expression on monocytes.

Methods

AT III concentration, IL-6 and TNF-α were measured by standard methods in 18 patients with sepsis. Levels of DR expression on monocytes are analysed flow cytometrically. The severity of the disease was assessed at the APACHE II-score. The substitution of antithrombin III (100 IE/h) was performed in patients with AT III-level <80%.

Results

There was a significant correlation between AT III and DR-expression on monocytes (P < 0.002). The substitution of AT III in a standard dose was associated with higher level of DR-expression on monocytes. Also the AT III level shows a linear correlation to IL-6 and TNF-α (P < 0.05; P < 0.03).

Conclusion

The results indicate that the AT III level is not only a marker of the disseminated intravascular coagulation in septic patients. Also there is a relationship to the process of inflammation. Higher levels of AT III were associated with a higher amount of DR-expression. Thus, the study confirmed the effect of AT III on the immunomodulation.