Studies on pathological plasma proteolysis in patients with septicemia

Plasma proteolysis was studied in surgical patients with septicemia by means of chromogenic peptide substrate assays. Using these methods both levels of proenzyme, functional inhibition capacity and enzyme activities indicating alpha 2-macroglobulin protease complexes were determined. In fatal cases continuous low values for prekallikrein, plasminogen and antithrombin III were found until death. At autopsy a persistent septic focus was found in all but one of the fatal cases. Very low levels of prekallikrein during sepsis and reduced functional inhibition of plasma kallikrein in septic shock indicated a poor prognosis. In the survivors the parameters returned towards the normal range upon successful therapy. Furthermore, the paper demonstrates the application of a new parameter, the Proenzymes functional inhibition index (PFI-index) in patients with septicemia. The data reveal that by means of this parameter, patients at high risks can be identified at an earlier stage of the disease than previously done.