Decreased protein C, protein S, and antithrombin levels are predictive of poor outcome in Gram-negative sepsis caused by Burkholderia pseudomallei
| Autor: | Andrew J.H. Simpson, Sau Chi Betty Yan, Steven P. LaRosa, Jeffrey D. Helterbrand, Wipada Chaowagul, Charles J. Fisher, Nicholas J. White, Barbara G. Utterback, Steven M. Opal |
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| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Microbiology (medical) Burkholderia pseudomallei Melioidosis Antithrombin 030204 cardiovascular system & hematology Ceftazidime Antithrombins Disease-Free Survival Protein S Proinflammatory cytokine Fibrin Fibrinogen Degradation Products Sepsis 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Aged Retrospective Studies Aged 80 and over biology General Medicine Middle Aged Thailand medicine.disease biology.organism_classification Anti-Bacterial Agents 3. Good health Imipenem Logistic Models Treatment Outcome Infectious Diseases Injections Intravenous Immunology biology.protein Cytokines Female Tumor necrosis factor alpha Biomarkers Protein C medicine.drug |
| Popis: | Summary Background Acute septicemic melioidosis is associated with systemic release of endotoxin and the proinflammatory cytokines tumor necrosis factor (TNF)-alpha, interleukin-1, and interleukin-6. Excessive release of these cytokines may lead to endothelial injury, depletion of naturally occurring endothelial modulators, microvascular thrombosis, organ failure, and death. Method Plasma samples drawn at baseline and after initial antimicrobial therapy in 30 patients with suspected acute severe melioidosis were assayed for D-dimer levels, protein C and protein S antigen levels, and antithrombin functional activities. Results Both baseline and continued deficiencies of protein C, protein S, and antithrombin were statistically associated with a poor outcome by logistic regression. Baseline D-dimer levels were significantly higher in fatal cases than survivors and correlated inversely with protein C and antithrombin, suggesting both increased fibrin deposition and fibrinolysis. Conclusion The inflammatory response to systemic Burkholderia pseudomallei infection leads to depletion of the natural endothelial modulators protein C, protein S, and antithrombin. Both baseline and continued deficiency of these endothelial modulators is predictive of poor outcome in melioidosis. |
| Databáze: | OpenAIRE |
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