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Association of mortality in the surgical ICU with plasma concentrations of plasminogen activator inhibitor-1 and soluble E-selectin

Introduction

Both plasminogen activator inhibitor-1 (PAI-1) and soluble E-selectin (sES) are substances activated by cytokines under strong inflammation. PAI-1 is a rapid inhibitor of tissue plasminogen in vivo. PAI-1 is known as one of the markers of systemic inflammatory response syndrome, which is followed by multiple organ dysfunctions. sES is an adhesion molecule that is expressed from endothelial cells activated by TNF. It is reported that elevation of sES is followed by respiratory failure, which causes acute respiratory distress syndrome. But it is not clear whether their plasma levels affect the mortality and morbidity of critically ill patients. We therefore divide patients into two groups by the plasma levels of PAI-1 and sES and evaluate the mortality respectively.

Methods

We compared the levels of PAI-1 and sES in survivors with those in nonsurvivors. We examined 29 patients admitted to our surgical ICU in the hospital of Kagoshima University. High levels of PAI-1 are known to be accompanied by hemorrhage after surgery. To evaluate, we therefore use the values of PAI-1 and sES on the admission day (day 1), day 2 and the day when hemorrhage is controlled. The plasma levels of PAI-1 and sES are measured by the latex agglutination assay with an automatic analyzer (LPIA-NV7; Mitsubishi Kagaku Iatron Co., Tokyo, Japan). For statistical analysis, a two-sided Fisher exact probability test was used to analyze the difference in the mortality. P < 0.05 indicated statistical significance.

Results

Among the patients examined, 11 patients showed elevated tPAI levels (>50 ng/ml) (PE group) and 18 patients showed normal tPAI levels (≤ 50 ng/ml) (PN group). Fourteen patients showed elevated sES levels (>30 ng/ml) (EE group) and 15 patients showed normal sES levels (<30 ng/ml) (EN group). Mortality is significantly higher in the PE group (9/11, 81.8%) and EE group (8/14, 57.1%) than in the PN group (1/18, 5.5%) (P < 0.0001) and EN group (2/15, 13.3%) (P < 0.0209), respectively.

Conclusion

Both the levels of PAI-1 and sES are useful for evaluating prognosis of critically ill patients in the surgical ICU.

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Yasuda, T., Nakahara, M., Kakihana, Y. et al. Association of mortality in the surgical ICU with plasma concentrations of plasminogen activator inhibitor-1 and soluble E-selectin. Crit Care 12, P207 (2008). https://doi.org/10.1186/cc6428

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Keywords

  • Systemic Inflammatory Response Syndrome
  • Acute Respiratory Distress Syndrome
  • Latex Agglutination
  • Agglutination Assay
  • Fisher Exact Probability Test