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Correlation With Severity of Disease

Marco Gardinali, MD; Pietro Padalino, MD; Sergio Vesconi, MD; Anna Calcagno, MD; Salvatore Ciappellano; Luisa Conciato, MD; Osvaldo Chiara, MD; Angelo Agostoni, MD; Angelo Nespoli, MD

Arch Surg. 1992;127(10):1219-1224.

Abstract
• Complement activation is necessary for an adequate immune and inflammatory response to infections. Activation releases anaphylatoxins that cause vasodilation, increase vascular permeability, and trigger release of polymorphonuclear neutrophil leukocyte (PMN) lysosomal enzyme and oxygen radicals. Under normal circumstances, an orderly progression of such events has a beneficial antimicrobial effect. The same mechanism, however, when uncontrolled, may damage host tissues. To provide information about the clinical importance of such events in sepsis, different complement parameters (C3, C4, and the desarginated forms of C3a [C3a_des-Arg] and C5a [C5a_des-Arg]), PMN elastase, and malondialdehyde (a by-product of membrane peroxidation by oxygen radicals) were measured daily in 26 septic patients and correlated with two objectively assessed and previously validated severity scores (acute physiology and chronic health evaluation [APACHE II] and Sepsis Severity Score [SSS]). Nonsurvivors (n=12) had significantly greater and longer lasting complement activation than that in survivors, as reflected by higher levels of catabolic peptides (C3a_des-Arg) and lower levels of native proteins (C3 and C4). C3a_des-Arg, C3, C4, and the C3a_des-Arg-C3 ratio were correlated with Sepsis Severity Scores. Polymorphonuclear neutrophil leukocyte elastase levels were higher in nonsurvivors and were correlated with C3a_des-Arg and the C3a_des-Arg-C3 ratio. Malondialdehyde levels were significantly higher in all patients than in controls, without, however, any relationship to severity of disease or clinical outcome. Since the higher and more persistent the complement activation and polymorphonuclear neutrophil leukocyte stimulation, the worse the patient's prognosis, we conclude that these mechanisms may be important in the clinical development of sepsis.

(Arch Surg. 1992;127:1219-1224)

Author Affiliations
From the Institute of Emergency Surgery (Drs Padalino, Chiara, and Nespoli), the Clinical Medicine (Drs Gardinali, Calcagno, Conciato, and Agostoni), Intensive Care Unit San Paolo Hospital (Dr Vesconi), and the Department of Food Science and Microbiology (Mr Ciappellano), University of Milan (Italy).

Footnotes
Accepted for publication November 9, 1991.

Reprint requests to Istituto de Chirurgia d'Urgenza, Università di Milano, Ospedale Policlinico IRCCS, via F Sforza 35-20122 Milano, Italia (Dr Padalino).

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