Elevated von Willebrand factor antigen is an early plasma predictor of acute lung injury in nonpulmonary sepsis syndrome.

Abstract

In this prospective study of 45 patients, we tested the hypothesis that markedly elevated levels of plasma von Willebrand antigen (vWf-Ag) a marker of endothelial cell injury, might predict the development of acute lung injury in patients with nonpulmonary sepsis syndrome. Acute lung injury was quantified on a four-point scoring system. At the time of entry into the study, none of the 45 patients had evidence of lung injury. Subsequently, 15 patients developed lung injury and 30 patients did not develop lung injury. The mean plasma vWf-Ag level was markedly elevated in the 15 patients who developed lung injury compared with the 30 patients who did not develop lung injury (588±204 vs. 338±196, percentage of control, P < 0.01). Furthermore, a plasma vWf-Ag level 2 450 was 87% sensitive and 77% specific for predicting the development of acute lung injury in the setting of nonpulmonary sepsis. In addition, the combination of a plasma vWf-Ag > 450 and nonpulmonary organ failure at the time of entry into the study had a positive predictive value of 80% for acute lung injury. Also, a plasma vWf-Ag level > 450 had a positive predictive value of 80% for identifying nonsurvivors. Thus, in patients with nonpulmonary sepsis, an elevated level of plasma vWf-Ag is a useful, early biochemical marker of endothelial injury and it has both predictive and prognostic value. (J. Clin. Invest. 1990. 86:474-480.) Key words: endothelial cells * acute lung injury* von Willebrand antigen level * sepsis * adult respiratory distress syndrome -shock

Biomarkers of endothelial dysfunction: can they help us deciphering systemic inflammation and sepsis?

“…Furthermore, plasma vWF-antigen levels were associated with the development of acute lung injury and 28-day survival. However, these data demonstrated moderate sensitivity (87%) and specificity (77%) (Rubin et al 1990;Sadler 1998). McGill et al (1998) also demonstrated that vWF might be useful to serve as prognostic marker, predicting survival with a positive predictive value by 80%.…”

“…The hypothesis that vWF may be increased in patients suffering from ARDS vs. only septic patients could not be fulfilled. The same observation was done, when comparing sepsis vs. non-septic patients with hyperinflammation (Rubin et al 1990). Thus, it seems that vWF is a marker for diagnosing hyperinflammation, without being able to discriminate between specific organ damage (i.e.…”

Fator von Willebrand e disfunção endotelial pulmonar. Implicações prognósticas

“…O retorno da função endotelial às condições de normalidade, é acompanhado de redução dos níveis circulantes aos limites fisiológicos. A atividade antigênica plasmática do fvW (vWF:Ag) é portanto, considerada universalmente como um marcador de disfunção endotelial e assim utilizada em várias doenças [11][12][13][14][15][16] . Em pacientes com hipertensão arterial pulmonar, os sintomas aparecem em etapas onde já existe considerável dano à microcirculação naquele território.…”

Biomarkers of Acute Lung Lesion

“…Более эффективны ми вариантами диагностики являются компонен ты, описывающие взаимоотношения эндотелия, активации нейтрофилов и прокоагулянтного зве на системы гемостаза [43][44][45].…”