Disturbances of selected plasma proteins in hyperdynamic septic shock

Abstract

Abstract. This study was performed on patients (n = 18) suffering from strictly defined hyperdynamic septic shock. Plasma faclors (C-reactive protein, acid al-glycoprotein, fibri nogen, fibrinopeptide A, fibrinogen-fibrin split products, factor XIII, antithrombin III, complement factors C3 and C4, interet-trypsin-inhibitor and CtrmacrogJobulin) measured during hyperdynamic septic shock were highly abnormal. The actjvation and consumption of dotting, fibrinolytic and complement factors due to systemspeeific proteinases (such as thrombokinase or plasminogen aetivators) seemed to be intensified by the nonspecific proteolytic activity of granuloeytic proteinases probably released by the action of endotoxins. Possible therapeutie measures {o maintain the endogeneous defenee meehanism against enhaneed proteolysis during septic shoek are diseussed.

Effect of Recombinant Hirudin, a Specific Inhibitor of Thrombin, on Endotoxin-induced Intravascular Coagulation and Acute Lung Injury in Pigs

“…The LPS-induced consumption of coagulation factors in the present study was similar to that observed in septic patients (2,30). The decrease in plasma Prothrombin and plasma fibrinogen and the increase in soluble fibrin in plasma are evidence of the generation of thrombin.…”

“…Heparin, the antithrombin III (AT III) cofactor, accelerates the reaction of AT III with thrombin and other clotting factors (29). Thus, the anticoagulant effectiveness of heparin depends on the concentration of AT III in plasma, which is low in cases of septic shock (30,31).…”

Protease-Activated Receptor 2–Mediated Vasodilatation in Humans In Vivo

“…Indeed, in a rat model, pretreatment with lipopolysaccharide substantially enhanced the sensitivity to the hypotensive response elicited by systemic administration of PAR-2-activating peptide. 20 Septic patients have a significant elevation in both circulating immunoreactive trypsin and endogenous trypsin inhibitors, 33 and immunoreactive trypsin levels have also been shown to correlate with risk of complications such as adult respiratory distress syndrome. 34 Circulating levels of trypsin are also elevated in the systemic inflammatory response observed in human acute pancreatitis, and both the overall severity of the illness 35 and the development of associated acute lung injury correlate with trypsin activity in a rat model of the disease.…”

Die klinische Wertigkeit biochemischer Faktoren beim Polytrauma

“…Die meisten dieser heute auch für den traumatisch-hämorrhagischen Schock als zutreffend anerkannten Pathomechanismen wurden zunächst sowohl tierexperimentell [224,226,260,261] als auch klinisch [4,37,229,266] …”

“…7 empfindlicher Marker für die akute entzündliche Reaktion bekannt. Dies konnte in klinischen Untersuchungen für septische Verläufe sowie das schwere Gewebetrauma bei großen Operationen und bei Polytrauma bestätigt werden [28,37,48,70,95,231,266]. Dem CRP scheint als Akutphasenprotein eine zentrale Stellung in der unspezifischen Infektabwehr zuzukommen [112].…”