RELEASED GRANULOCYTIC ELASTASE - AN INDICATOR OF PATHO-BIOCHEMICAL ALTERATIONS IN SEPTICEMIA AFTER ABDOMINAL-SURGERY

  • 1 January 1985
    • journal article
    • research article
    • Vol. 98  (5) , 892-899
Abstract
To discover the role of lysosomal enzyme release from polymorphonuclear (PMN) leukocytes during septicemia, plasma levels of PMN elastase were measured with a newly developed enzyme-linked immunosorbent assay for detection of the PMN elastase-.alpha.1-proteinase inhibitor complex (E-.alpha.1PI). Plasma samples from 41 patients were assayed continuously before and after major abdominal surgery. The patients were divided into a group without infection (group A) and two septicemia groups (survivors in group B and nonsurvivors in group C). The E-.alpha.1 PI levels of the 11 patients in group A without any signs of pre- or postoperative infection were in the normal range (a normal value of 86.5 .+-. 25.5 ng/ml has been reported in 153 healthy subjects), except for a small increase to 208.8 .+-. 25.6 ng/ml 12 hours after surgery. When septicemia was confirmed clinically in patients in groups B and C, the E-.alpha.1PI levels rose on average to six times the norm in group B (649.9 .+-. 116.3 ng/ml) and to more than 10 times the norm in group C (985.0 .+-. 154.6 ng/ml). Peak values > 2,200 ng/ml could be measured in both groups. In patients in group B, the E-.alpha.1PI levels returned to normal during recovery, while in those in group C they remained significantly elevated (560.5 .+-. 174.7 ng/ml) until death. Correlations were demonstrated between the amount of elastase released into the circulation and the decrease in the activities of antithrombin III, coagulation factor XIII, and .alpha.2-macroglobulin, as well as the increased C-reactive protein in plasma. We conclude that release of elastase and other lysosomal factors from PMN cells plays a major role in the pathobiochemical alterations during septicemia. In addition, significantly elevated E-.alpha.1PI levels in the postoperative course seem to be a suitable indicator for onset and persistance of sepsis as well as of the severity of this disorder in patients after major surgery.