Platelet-activating factor and phospholipase A2 in patients with septic shock and trauma

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Abstract
To study blood and bronchoalveolar lavage (BAL) fluid levels of platelet activating factor (PAF-acether) and phospholipase A2 (PLA2) in patients with septic shock or following severe trauma. Prospective controlled clinical study. An intensive care unit (ICU) of a university hospital. The study comprised 12 patients, 8 with septic shock and 4 with trauma, consecutively admitted to the ICU. Healthy volunteers were used as controls. Blood PAF-acether and plasma PLA2 levels were measured within 24 h after the patients arrival to the ICU. The Apache II score and outcome were registered. Median values for PAF-acether and PLA2 in the septic shock patients were 10.5×10−10 M and 5300 units/ml, respectively, whereas corresponding values in the trauma patients were 1.3×10−10M and 770 units/ml. Normal healthy individuals had no detectable PAF-acether in the circulating blood (−10 M), and normal plasma PLA2 activity was 2 and PAF-acether levels correlated well with the severity of the disease as assessed by the Apache II scoring system (p2 andp2 were determined in BAL fluid of patients with septic shock (n=5) and trauma (n=3); increased PAF-acether levels were found in four patients with septic shock and one patient with trauma. These results demonstrate a significant increase of both PLA2 and PAF-acether in the circulation of trauma patients, and a further increase in septic shock patients. It is possible that PAF-acether and PLA2 can be used as markers for the severity of the disease in septic shock and following severe trauma.