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Serial change of C1 inhibitor in patients with sepsis--a preliminary report
Tomoya Hirose1, Hiroshi Ogura1, Jinkoo Kang1
1Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan.
Insights
In sepsis patients, low C1 inhibitor (C1INH) levels and activity were observed in refractory shock cases. Further research into C1INH replacement therapy could improve sepsis management strategies.
Area of Science:
- Biochemistry
- Immunology
- Critical Care Medicine
Background:
- C1 inhibitor (C1INH) is crucial for regulating complement, kallikrein-kinin, fibrinolytic, and coagulation systems.
- C1INH exhibits anti-inflammatory and vascular permeability regulatory functions.
- Understanding C1INH dynamics in sepsis is vital for patient outcomes.
Purpose of the Study:
- To investigate the serial changes in C1 inhibitor (C1INH) levels and activity in patients experiencing sepsis.
- To correlate C1INH dynamics with clinical outcomes, particularly in cases of refractory septic shock.
Main Methods:
- Serial measurements of C1INH activity and quantitative values were performed in sepsis patients admitted to the ICU.
- Patients were categorized based on the presence or absence of refractory shock, defined by steroid-dependent hemodynamics.
- Clinical courses of patients were analyzed alongside C1INH measurements.
Main Results:
- One non-survivor with refractory shock showed low C1INH activity and quantitative values on admission.
- A patient with refractory shock who improved had initially low C1INH values that increased with recovery.
- Non-refractory shock patients generally presented with normal or elevated C1INH levels.
Conclusions:
- Refractory septic shock is associated with diminished C1INH activity and low quantitative values.
- The findings suggest a potential role for C1INH in sepsis pathogenesis and severity.
- Further investigation into C1INH replacement therapy for septic shock patients may offer novel management approaches.
Objective:
C1 inhibitor (C1INH) regulates not only the complement system but also the plasma kallikrein-kinin, fibrinolytic, and coagulation systems. The biologic activities of C1INH can be divided into the regulation of vascular permeability and anti-inflammatory functions. The objective was to clarify the serial change of C1INH in patients with sepsis.
Methods:
We serially examined C1INH activity values (reference range, 70%-130%) and quantitative values (reference range, 160-330 μg/mL) in patients with sepsis admitted into the intensive care unit of the Trauma and Acute Critical Care Center at Osaka University Hospital (Osaka, Japan) during the period between December 2012 and February 2013. We also analyzed their clinical course. We defined "refractory shock" as septic shock requiring steroid administration to maintain hemodynamics.
Results:
The serial change of C1INH was evaluated in 5 patients (4 survivors and 1 nonsurvivor). Two patients were diagnosed as having refractory shock. In the nonsurvivor after refractory shock, C1INH activity on admission was 97.2%, and the quantitative value was 133.1 μg/mL. In the other patient with refractory shock, C1INH activity on admission was 94.4%, and the quantitative value was 126.7 μg/mL. This patient's general condition had improved by day 6, with increases in C1INH activity (139.9%) and quantitative value (250.1 μg/mL). In the 3 nonrefractory shock patients, C1INH activity on admission was 130.6%±8.7%, and the quantitative value was 215±26.5 μg/mL.
Conclusions:
Enhancement of C1INH activity was not observed in the refractory shock patients, and the C1INH quantitative values were low. Further evaluation of the serial change of C1INH and the validity of C1INH replacement therapy in patients with septic shock may lead to a new strategy for sepsis management.
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