KININ ACTIVATION IN BLOOD OF PATIENTS WITH SEPSIS

  • 1 January 1976
    • journal article
    • research article
    • Vol. 143  (4) , 539-545
Abstract
To determine whether kinin activation in the blood during severe infection with gram-negative bacteria is related to hemodynamic abnormalities encountered, blood prekallikrein, kallikrein inhibitor and kinin values in 21 surgical patients with sepsis were compared with those in normotensive and hypotensive patients. Because of reduced prekallikrein synthesis in patients with hepatic insufficiency, the normotensive and hypotensive groups were subdivided according to the presence or absence of liver dysfunction, as indicated by elevated blood bilirubin, serum glutamic-oxalacetic transaminase or alkaline phosphatase levels. The mortality was zero in group 1, normotensive-normal liver function; 20% in group 3, normotensive liver dysfunction; and 67% in group 4, hypotensive liver dysfunction. The majority of deaths were due to respiratory failure. Although the blood prekallikrein level, was below normal in all groups and was significantly less in all patients with liver dysfunction, it was reduced proportionately in hypotensive patients to < 30% of the values noted in the 2 normotensive groups. Prekallikrein consumption in the hypotensive groups may be the result of the process of activating kallikrein and bradykinin. This concept is supported by finding elevated kinin values, > 3 ng/ml plasma, in only 28% of those in group 1 and 12% of those in group 3, while in the hypotensive patients, groups 2 and 4, the kinin level was elevated in 60 and 66%, respectively.

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