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Related Experiment Videos

Fibrinolysis in critically ill patients.

R Moalli1, J M Doyle, H R Tahhan

  • 1Pulmonary Division, Rhode Island Hospital, Providence 02903.

The American Review of Respiratory Disease
|August 1, 1989
PubMed
Summary

Elevated plasminogen activator inhibitor (PAI-1) and Factor VIII-related antigen (VIII:Ag) are common in critically ill patients. However, these markers may not reliably predict the development of adult respiratory distress syndrome (ARDS).

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Area of Science:

  • Critical Care Medicine
  • Pulmonary Medicine
  • Hematology

Background:

  • Impaired fibrinolysis is implicated in adult respiratory distress syndrome (ARDS) pathogenesis.
  • Elevated plasminogen activator inhibitor-1 (PAI-1) may inhibit normal fibrinolysis, potentially unmasking alternative pathways like elastase-induced degradation.
  • Factor VIII-related antigen (VIII:Ag) is a potential marker for acute lung injury.

Purpose of the Study:

  • To investigate the role of PAI-1 and elastase-induced fibrin(ogen) degradation products in critically ill patients.
  • To assess whether PAI-1, VIII:Ag, elastase-induced peptides, and alpha-1-protease inhibitor (alpha-1-PI) can serve as predictive markers for ARDS development.

Main Methods:

  • Measured plasma PAI-1, elastase-induced peptides, VIII:Ag, and alpha-1-PI in 69 critically ill patients and 9 healthy volunteers.

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  • Classified patients into MICU controls, at-risk for ARDS, and ARDS groups.
  • Utilized chromogenic assay, radioimmunoassay, immunoelectrophoresis, and immunodiffusion for measurements.

    • Main Results:

    • MICU controls exhibited elevated PAI-1, VIII:Ag, elastase-induced peptides, and alpha-1-PI compared to healthy volunteers.
    • Patients with ARDS showed significantly higher PAI-1 and VIII:Ag than MICU controls.
    • Elastase-induced peptides and alpha-1-PI were not significantly different in ARDS patients.
    • At-risk patients without ARDS also presented with elevated PAI-1 or VIII:Ag.

    Conclusions:

    • PAI-1 and VIII:Ag are frequently elevated in critically ill patients, irrespective of ARDS development.
    • These markers may not be sufficiently specific to predict the onset of ARDS.
    • Further research is needed to elucidate the precise role of fibrinolytic components in ARDS pathogenesis.