美洲大蠊提取物对重型颅脑损伤患者的胃肠黏膜屏障功能的影响

目的 研究美洲大蠊提取物对重型颅脑损伤患者胃肠黏膜屏障功能的影响.方法 2009-01 ～2011-01随机将42例重型颅脑损伤患者分为治疗组和对照组,对照组给予相应综合抢救措施,治疗组在对照组救治基础上给予美洲大蠊提取物.分别观察患者治疗前、治疗后1、3、7 d APACHEⅡ评分、胃肠功能评分变化.记录应激性消化道溃疡、死亡的发生率.结果 治疗前两组APACHEⅡ评分、胃肠功能评分比较差异无统计学意义(P＞0.05);治疗后3、7d治疗组APACHEⅡ评分、胃肠功能评分明显降低,两组比较差异有统计学意义(P＜0.05);7d内治疗组应激性消化道溃疡发生率低于对照组(P＜0.05).结论 美洲大蠊提取物对重型颅脑损伤患者的胃肠黏膜屏障功能具有保护作用,能在一定程度上改善重型颅脑损伤患者的病情.     

血乳酸和D-二聚体测定在全身炎症反应综合征中的意义

目的　探讨血乳酸 (LA)和D -二聚体 (D -dimer)在全身炎症反应综合征 (SIRS)时的变化、相关性及与预后的关系。方法　满足SIRS诊断标准的住院病人 10 0例为SIRS组 ,并按满足 2项、3项、4项标准分为S1、S2 、S3 亚组 ,按照预后分为生存组和死亡组 ;不满足SIRS诊断标准的急诊病人 5 0例为非SIRS组 ;健康正常人 5 0例为对照组。分别测定LA和D -dimer。结果　SIRS组LA和D -dimer均高于非SIRS组及对照组 (P <0 .0 1) ,SIRS组LA和D -dimer在S3 亚组高于S1亚组 (P <0 .0 5 ) ,死亡组高于生存组 (P <0 .0 5 ) ,SIRS组LA与D -dimer呈明显正相关 (P <0 .0 1) ,LA和D -dimer均与预后呈负相关 ,经检验 ,D -dimer与预后呈明显负相关 (r=- 0 .2 90 3,P<0 .0 1)。结论　LA、D -dimer在SIRS病人明显升高 ,二者呈正相关 ,D -dimer可能是SIRS预后的标记物。     

Sweet's syndrome associated with systemic inflammatory response syndrome

Septic shock is characterised by infection causing a systemic inflammatory response, end-organ failure and acute circulatory collapse. Treatment consists of antimicrobial therapy and the supportive management of multi-organ failure. We report a case of what we believed to be septic shock due to pyelonephritis in a patient whose condition continued to deteriorate despite conventional treatment until the diagnosis of Sweet's syndrome was made. Once she was started on high dose steroids, her condition improved and she made a full recovery. We believe this to be the first case of a severe systemic inflammatory response syndrome associated with Sweet's syndrome. Received: 20 January 1998 Accepted: 12 June 1998     

C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome

Objective To assess the diagnostic value of a single determination of serum C-reactive protein as a marker of sepsis in critically ill patients.Design Prospective, observational study.Setting Intensive care unit of a university hospital.Patients and participants One hundred twenty-five adult patients with systemic inflammatory response syndrome (SIRS) (55 patients without evidence of infection and 70 patients with the diagnosis of sepsis confirmed by documented infection). Twenty-five patients with non-complicated acute myocardial infarctions (AMI) and 50 healthy volunteers were used as controls.Interventions None.Measurements and results Serum C-reactive protein concentration was measured within the first 24 h of SIRS onset. Healthy subjects, AMI and non-infectious SIRS patients showed lower C-reactive protein median values ([(0.21 [95% confidence intervals (95% CI), 0.21–0.4] mg/dl, 2.2 [95% CI, 2.1–4.9] mg/dl and 1.7 [95% CI, 2.4–5.5] mg/dl, respectively) than patients with sepsis (18.9 [95% CI, 17.1–21.8]), p<0.001. The presence of severe sepsis (r_s=0.27; p=0.03), SOFA score (r_s=0.25; p=0.03) and arterial lactate (r_s=0.24; p=0.04) correlated significantly with C-reactive protein concentrations in sepsis cases. The best threshold value for C-reactive protein for predicting sepsis was 8 mg/dl (sensitivity 94.3%, specificity 87.3%). The area under the receiver-operating characteristic curve for C-reactive protein was 0.94 (95% CI, 0.89–0.98).Conclusions Determination of serum C-reactive protein can be used as an early indicator of infection in patients with SIRS.Supported in part by Red Respira (isciii-RTIC C03/11), CIRIT SGR 2001/414 and Distinció a la Recerca Universitaria (JR).     

多发伤患者全身炎症反应综合征与多器官功能障碍综合征关系探讨

目的 探讨多发伤后全身炎症反应综合征（SIRS）和多器官功能障碍综合征（MODS）关系及防治策略。方法 回顾性分析652例多发伤患者入院时、入院3天后的临床资料。结果 多发伤患者入院时SIRS的发生率为39.3%,MODS的发生率为20.3%,病死率为10.9%;其中严重多发伤患者（106例）的SIRS发生率、MODS发生率和病死率是88.7%、34.9%和18.9%;3天后仍伴有SIRS的164例,其MODS的发生率和病死率是32.9%和17.7%,明显高于非SIRS组及入院时SIRS组（P〈0.05）;61例（9.4%）发生MODS的病死率为54.1%（33/61）。结论 积极治疗原发性损伤,防止创伤治疗过程中的第二次打击,阻断SIRS或脓毒血症向MODS发展进程,是改善多发伤预后的关键。     

全身炎症反应综合征患者血清前白蛋白和透明质酸变化及意义

目的　观察全身炎症反应综合征 (SIRS)患者血清前白蛋白 (PAB)和透明质酸 (HA)水平变化并探讨其临床意义。方法　符合SIRS诊断 4 8例 ,清晨空腹抽肘静脉血 5mL ,采用免疫散射比浊法检测PAB含量 ,放射免疫法检测HA含量 ,并选择健康体检者 4 1例作为对照组。结果　SIRS患者血浆PAB含量比对照组显著下降 (P <0 0 1) ;而血浆HA水平与对照组比较明显升高 (P <0 0 1) ;氧合指数与对照组比较无显著差异 (P >0 0 5 )。器官功能不全组血浆PAB含量比器官功能正常组更低 (P <0 0 5 ) ;而血浆HA水平高于器官功能正常组 (P <0 0 1)。结论　SIRS患者血浆PAB、HA水平变化可作为判断病情和监测MODS发生的敏感指标 ,并提示在治疗疾病过程中护肝治疗是重要一环。     

肾功能多指标联测在SIRS中早期肾功一能损害的诊断与预测价值

目的：动态监测肾功能多指标联检、观察全身炎症反应综合征（SIRS）至多脏器功能障碍综合征（MODS）时肾功能的变化,肾脏损害部位及程度,寻找一个安全、可靠、简易易推广的早期诊断急性肾功衰竭的方法。方法：选择我院急诊ICU符合SIRS标准56例,其中29例发生急性肾功能衰竭。采用放射免疫法测定血内皮素（ET）、尿微量蛋白系列：尿白蛋白（ALB）、尿免疫球蛋白G（IgG),尿转铁蛋白（TRF）、α1－微球蛋白（α1－MG）、β2－微球蛋白（β2－MG）并与常规尿蛋白、血BUN、Cr进行比较,并计算排钠指数。结果：肾功多指村联测总阳性率及单项指标阳性率均高于血BUN、Cr常规尿蛋白折阳性率。差异有显著意义,P＜0．01。尿微量蛋白系列的变化可出现在SIRS期早于传统生化指标和常规尿蛋白的测定。结论：肾功能多指标动态监测可作为判断SIRS期至MODS早期肾功能状态的又一临床指标。对指导临床、防治MODS的发生,评估预后有一定的实用价值。     

全身炎症反应综合征患者抗炎因子对T淋巴细胞凋亡的影响

目的：探讨全身炎症反应综合征（SIRS）患者抗炎症细胞因子对T淋巴细胞（简称T细胞）凋亡的影响。方法：符合SIRS诊断42例，分别在入院当天和第2、4天清晨空腹抽肘静脉血3ml，测定转化细胞生长因子－β（TGF－β）、白介素－10（IL－10）和CD3^ T细胞、CD95^ T细胞，并设对照组。结果：TGF－β和IL－10入院第1天起持续升高，与对照组比较差异有显著性意义（P＜0．01）：CD3^ T细胞和CD95^ T细胞入院当天即降低，第2天后更低，与对照组比较差异有显著性意义（P＜0．05，P＜0．01）；TGF-β与CD3^ T细胞、CD95^ T细胞具有显著的相关性（γ=-0.715,-0.672)；IL-10与CD3^ T细胞、CD95^ T细胞呈显著的相关性（γ=-0.597,-0.604)。结论：抗炎因子诱导T淋巴细胞凋亡增加，总数减少和免疫功能紊乱；适度拮抗抗炎症细胞因子，使致炎因子与抗炎因子达到平衡，可能有利于SIRS的控制。     

全身炎症反应综合征患者凝血功能的研究

目的 研究全身炎症反应综合征(SIRS)患者凝血功能的变化,为采用抗凝治疗提供理论基础.方法 将入住重症监护病房的患者分为SIRS组30例,非SIRS组25例,另选取健康对照组30例,分别检测血小板计数(PLT)、血浆凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(DD)等与凝血功能有关的实验室指标.结果 SIRS组中PT、TT、APTT、DD[分别为(16.48±1.57)、(22.67±1.48)、(43.56±4.33)s与(2.25±0.18)mg/L]均高于非SIRS组[分别为(12.83 ±1.23)、(17.05±1.97)、(33.34±2.38)s与(0.58 ±0.15)mg/L]及健康对照组[分别为(12.04±0.98)、(16.88±1.37)、(29.84±1.98)s与(0.43 ±0.11)mg/L](P均<0.05),PLT、FIB[分别为(110.69±50.23)×109/L、(2.05±0.33)g/L]均低于非SIRS组[分别为(180.58±45.70)×109/L、(3.54±0.29)g/L]及健康对照组[分别为(204.95±46.83)×109/L、(3.78±0.54)g/L](P均<0.05).结论 SIRS患者存在凝血功能紊乱,其主要表现为凝血激活,促凝物质增加、抗凝物质减少、纤溶系统受抑制,凝血系统异常可能在SIRS的发生、发展过程中起重要作用.     

The systemic inflammatory response syndrome induces functional changes and relative hyporesponsiveness in neutrophils

Purpose

To study the effects of systemic inflammatory response syndrome (SIRS) on polymorhonuclear neutrophil (PMN) function and phenotype by comparing neutrophils from critically ill patients with SIRS against those from healthy blood donors.

Material and Methods

Intensive care unit patients (n = 110) who met at least one SIRS criterion were recruited to the study. One hundred healthy blood donors were recruited as normal controls.

Results

Polymorphonuclear cells from critically ill patients with SIRS were more resistant to activation than PMNs from healthy donors, but when stimulated had an exaggerated microbicidal response. Buffer-treated PMNs from patients with SIRS had significantly higher CD43 surface expression that may inhibit heterotypic cellular contact or ligand stimulation of membrane receptors, had significantly lower expression of IgG receptor CD16, demonstrated resistance to shedding of L-selectin when primed by platelet-activating factor which could be pro-inflammatory, and had reduced respiratory burst when primed by platelet-activating factor than activated by formyl-Met-Leu-Phe.

Conclusion

The phenotypic and functional changes observed in neutrophils in the critically ill indicate that they require a higher level of stimulus to become activated. This may represent an auto-protective mechanism where the neutrophils in the already inflamed host may, by this mechanism, avoid excessive inflammation reducing the risk of further host cell injury and death.     

全身炎症反应综合征患者血脂变化与炎症反应的相关性研究

目的观察全身炎症反应综合征(SIRS)患者血浆高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、总胆固醇(TC)、三酰甘油(TG)和肿瘤坏死因子(TNF-α)水平的变化,探讨血脂变化在炎症反应中的意义。方法符合SIRS诊断48例,分别在入院后第1、3和第5天清晨空腹抽肘静脉血3mL,测定HDL、LDL、TC、TG和TNF-α,并设对照组。结果SIRS患者血浆HDL、LDL、TC、TG入院后各监测点均比对照组显著下降(P<0.01,P<0.05),HDL入院第3天为最低,并且降低更为显著(P<0.01)。SIRS患者TNF-α入院后各监测点均比对照组显著升高(P<0.05,P<0.01)。HDL、LDL、TC、TG与TNF-α具有相关性(P<0.05,P<0.01)。结论机体过度炎症反应时,HDL、LDL、TC、TG水平下降,并且与炎症反应的程度密切相关,可作为评估预后的一个参考指标;在治疗原发病的基础上,提高血脂和脂蛋白水平,有助于缓解病情,改善预后。     

263例烧伤后全身炎性反应综合征临床分析

目的：探讨烧伤后全身炎性反应综合征（SIRS）的诊断、治疗以及对多脏器功能失常综合征（MODS）转归的影响。方法：根据美国胸科医生学会（ACCP）和危重病医学会（SCCM）制定的标准诊断，同时参照APACHEⅡ评分系统、烧伤严重程度、全身感染情况等确定SIRS的严重程度。治疗方法分为烧伤休克的治疗、全身治疗和创面治疗3部分进行。结果：263例中，轻、中度SIRS135例（51．3％）；重度SIRS128例（48．7％），APACHEⅡ评分均＞10分。发生各种严重并发症41例（15．6％），其中并发MODS18例，占并发症发生率的43．9％；死亡19例（7．22％），128例重度SIRS中死亡17例，占死亡总数的89.5%。结论：严重烧伤后由于二次打击因素的存在,SIRS发生率高，与MODS的发病和预后密切相关。高度重视SIRS向MODS转变过程中的高危因素，阻断或消弱二次打击是防治SIRS最有力的措施。     

The systemic inflammatory response syndrome (SIRS) to identify infected patients in the emergency room

Objective Evaluation of the usefulness of criteria for systemic inflammatory response syndrome (SIRS) compared with the final diagnosis of infection in patients admitted to the emergency room of two university-based hospitals.Design Longitudinal cohort study.Setting Hospital Universitario San Vicente de Paul and Hospital General de Medellín, Medellín, Colombia.Patients Seven hundred thirty-four patients with suspected infection as main diagnosis for admittance into the emergency room.Measurements and results Sensitivity, specificity, predictive values and likelihood ratios (LR) of SIRS criteria at admission were determined using, as gold standards, the diagnosis at the time of discharge based on clinical history and evolution, and microbiological confirmation of infection. SIRS criteria were met by 503 patients (68.5%); the discharge diagnosis of infection was found in 657 (89.4%) and 276 (37%) had microbiological confirmation. SIRS criteria exhibited a sensitivity of 69%, specificity of 35%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 12% and positive LR of 1.06. There were no differences between the two gold standards.Conclusions The finding of two or more SIRS criteria was of little usefulness for diagnosis of infection. It is necessary to work with new criteria and probably with biological markers, in order to obtain a simple, precise and operative definition of the sepsis phenomenon.This study was carried out at the Department of Internal Medicine, School of Medicine, University of Antioquia, Medellin, Colombia, and was support by CODI, University of Antioquia     

大黄对全身炎症反应综合征患者肾功能的影响

目的 :探讨大黄对全身炎症反应综合征 (SIRS)患者肾功能的影响。方法 :将 6 2例无肾功能不全的SIRS患者随机分成两组 ,对照组 (30例 )给予常规对症支持治疗 ,中西医结合治疗组 (32例 )加用生大黄泡水鼻饲 5 d。分别检测所有患者治疗前、治疗 2 4 h后、治疗 12 0 h后的血浆内皮素、血肌酐、尿微量白蛋白和 β2 微球蛋白。结果 :治疗 12 0 h后 ,治疗组上述 4项指标均较对照组明显降低 (P<0 .0 5或 P<0 .0 1)。结论 :大黄对SIRS患者的肾功能有保护作用。     

Elevation in interleukin 13 levels in patients diagnosed with systemic inflammatory response syndrome

Objective To examine plasma levels and circadian rhythm of interleukin 13 (IL-13), tumour necrosis factor (TNF) α and total serum cortisol in the systemic inflammatory response syndrome (SIRS). Design and setting Prospective observational study in a 12-bed medical-surgical ICU of a 500-bed university hospital. Patients Ten patients with SIRS and eight controls. Measurements Arterial blood was sampled hourly for 24 h for measurement of plasma IL-13, TNF- α, cortisol and white blood cell count (WCC) differential within 24 h of development of SIRS. Results There were significantly higher plasma IL-13 levels in SIRS patients than in controls (1282 vs. 713 pg/ml). IL-13 was significantly higher in patients with a diagnosis of sepsis than in those with non-infectious causes of SIRS (2080 vs. 515 pg/ml). In SIRS the elevation in IL-13 was associated with higher TNF-α and reduced WCC. A circadian rhythm was observed in plasma IL-13 secretion. No distinct circadian rhythm was noted for TNF- α, and the normal circadian rhythm of serum cortisol was lost. Conclusions The anti-inflammatory cytokine IL-13 is elevated in early SIRS. Its plasma level exhibits a circadian rhythm and may be modulated in part by TNF-α. SIRS patients have disruption of the normal circadian rhythm of serum cortisol.     

降钙素原对全身炎症反应综合征患者病情预后的判断价值

目的 探讨血清降钙素原(PCT)与C-反应蛋白(CRP)、白细胞计数(WBC)对全身炎症反应综合征(SIRS)病情评估和预后判断的价值.方法 采用前瞻性病例对照方法,选择本院重症监护病房(ICU)2010年5月至2011年6月收治的SIRS患者72例,于患者入ICU 1、3、5d分别测定外周静脉血PCT、CRP及WBC.按有无感染灶分为脓毒症组(49例)和非脓毒症组(23例),比较两组间各指标动态变化的差异,将有差异的指标与序贯器官衰竭评分( SOFA)进行相关性分析;随访28d临床结局,分为死亡组(19例)和存活组(53例),比较两组间各指标动态变化的差异;用受试者工作特征曲线(ROC曲线)下面积(AUC)分析相关指标预测28 d生存情况的效能,用多因素logistic回归分析筛选其预测死亡的独立危险因素.结果 脓毒症组入ICU 1、3、5dPCT(μg/L)均明显高于非脓毒症组(1 d:2.5±0.3比0.9±0.2,3 d:1.9±0.3比0.6±0.2,5 d:0.9±0.1比0.5±0.1,均P＜0.05),而CRP及WBC与非脓毒症组比较差异无统计学意义;脓毒症组随治疗时间延长 PCT逐渐降低,各时间点比较差异有统计学意义(均P＜0.05),而在非脓毒症组PCT水平与治疗时间无关;PCT与SOFA评分存在显著正相关( r=0.979,P＜0.05).死亡组患者入ICU 1、3、5 dPCT( μg/L)、CRP(mg/L)均明显高于存活组(PCT 1 d:2.0±0.8比0.8±0.3,3 d:2.2±0.7比0.6±0.3,5 d:2.4±1.0比0.4±0.1;CRP 1 d:422±45比411±44,3 d:418±39比403±52,5 d:392±38比382±46,均P＜0.05),而WBC与存活组比较差异无统计学意义;存活组随治疗时间延长PCT显著下降,各时间点比较差异有统计学意义(均P＜0.05),在死亡组与治疗时间无关,PCT持续在较高水平;而CRP、WBC随时间变化在两组间无明显差异.PCT和CRP预测患者28d生存的AUC分别为0.824和0.720(均P＜0.01);多因素logistic回归分析显示,PCT＞2.23 μg/L是预测预后的独立危险因素[优势比(OR值)=1.773,95％可信区间(95％CI)为(1.033,3.214),P=0.015].结论 SIRS患者血清PCT有助于早期鉴别脓毒症与非脓毒症,动态监测PCT可预警病情严重程度及预后,可能是预测28 d生存情况的独立危险因素.     

血清胆碱酯酶对老年全身炎症反应综合征患者预后的预测作用

目的 研究分析血清肌碱酯酶对老年全身炎症反应综合征患者病情发展转归的预测作用.方法 将124例入住浙江大学医学院附属第二医院中心监护室(ICU)的老年SIRS患者根据预后情况分为存活组和死亡组.检测所有入院患者24 h内的血清胆碱酯酶、白蛋白、D-二聚体、乳酸、C反应蛋白(CRP),并进行APACHEⅡ和GCS评分.结果 生存组和死亡组之间比较,在年龄、性别、APACHEⅡ评分、GCS评分方面差异无统计学意义(P＞0.05).血乳酸、血D-二聚体、白蛋白、CRP、ChE在两组间比较差异具有统计学意义(P值=0.011,0.011,0.007,0.008,0.000.).预后多因素回归分析结果显示性别、年龄、白蛋白、CRP、GCS评分、APACHEⅡ评分、乳酸、D-二聚体不是决定患者预后的独立危险因素(P值分别为0.401,0.165,0.446,0.841,0.615,0.120,0.502,0.184),但ChE有显著性相关(P=0.000).ROC曲线图分析显示血清ChE对老年SIRS患者预后的ROC曲线下面积(AUC)为0.797,SE=0.04,P=0.000;ChE=103.00U/L时,敏感度为:0.793;1-特异度为0.258,可作为诊断的切点.Kendall相关分析ChE与APACHEⅡ评分、CRP、白蛋白相关性非常弱,相关系数分别为0.061,0.231,-0.090,P值分别为0.161,0.000,0.069.结论 ChE可能参与了老年SIRS的发生和发展过程,对这类患者的病情发展转归有一定的预测作用,且指标稳定,受干扰因素少.     

Systemic inflammatory response syndrome in intravascular lymphomatosis

Intravascular lymphomatosis (IVL) is characterized by an intravascular proliferation of atypical mononuclear cells of haematopoietic origin occluding small blood vessels including venules, capillaries and small arteries, and can affect virtually any organ in the body. Clinically, the most common manifestations are involvement of the skin and central nervous system, although various organ involvement has been described. We report a patient who presented with fever and rash, and succumbed with acute neurological symptoms and systemic inflammatory response syndrome (SIRS) with no evidence of infection. The postmortem revealed disseminated involvement of virtually every organ with IVL, the malignant cells being of T-cell origin, which may secrete cytokines including tumour necrosis factor and interleukin-1, that are believed to be mediators in SIRS. In the absence of evidence of infection on microbiology and pathology, we postulate that the features of SIRS in this patient was due to the disseminated malignancy itself. Received: 24 April 1996 Accepted: 6 May 1997     

Prognostic significance of urokinase-type plasminogen activator and its receptor in patients with systemic inflammatory response syndrome

BACKGROUND:

This study aimed to determine the plasma levels of urokinase-type plasminogen activator (uPA), urokinase-type plasminogen activator receptor (uPAR), D-dimer, IL-6 and TNF-α and observe the relations among uPA, uPAR, D-dimer, IL-6 and TNF-α in patients with systemic inflammatory response syndrome (SIRS).

METHODS:

A prospective, clinical case-control study was conducted in patients with SIRS at age of more than 55 years old treated during 2008-2010 at Wuhan Central Hospital. Venous blood samples were collected by routine venipuncture. Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS: SIRS patients from intensive care units (n=50), and non-SIRS patients from medical wards (n=35). Thirty healthy blood donors who visited the General Health Check-up Division at Wuhan Central Hospital served as controls. Excluded from the study were (1) those patients with pregnancy; (2) those with cancer; (3) those died after admission into the ICU in 7 days; (4) those received cardiopulmonary resuscitation; (5) those who had previous blood system diseases; and (6) those with SIRS before admission into the ICU. The levels of uPA, uPAR, D-D, IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kit. The data were analyzed using SPSS version 17.0 and expressed as mean ± standard. Student''s t test and the Mann-Whitney U test were used in the analysis. The relations of uPA, uPAR and D-dimer, IL-6 TNF-α levels were analyzed using Spearman''s rank-order correlation coefficient test.

RESULTS:

The plasma levels of uPA, uPAR, D-dimer,IL-6 and TNF-α in the patients with SIRS were obviously higher than those in the non-SIRS patients and controls (P<0.001). Correlation analysis showed a positive correlation between uPAR and IL-6 levels (r=0.395, P=0.004) and between uPAR and TNF-α levels (r=0.606, P<0.001), but no correlation between uPAR and D-dimer levels (r=0.069, P=0.632). No correlation was observed between uPA, D-dimer, IL-6 and TNF-α levels (P>0.05). The establishment of ROC curve was based on the levels of uPAR, D-dimer, IL-6 and TNF-α in 24 hours for the diagnosis of multiple organ dysfunction syndrome (MODS), and the ROC areas under the curve were 0.76, 0.58, 0.86 and 0.83, respectively.

CONCLUSIONS:

uPA and uPAR play a major role in patients with SIRS in the process of coagulation disorder, but the mechanism of SIRS is not the same. uPAR may play a central role in the development of SIRS to MODS.KEY WORDS: Systemic inflammatory response syndrome, Multiple organ dysfunction syndrome, D-dimer, Interleukin-6, Tumor necrosis factor-alpha, Coagulant function     

Increased incidence and severity of the systemic inflammatory response syndrome in patients deficient in mannose-binding lectin

Objective To determine whether pediatric PICU patients with mannose-binding lectin (MBL) gene polymorphisms associated with low levels of the functional protein have an increased risk of developing sepsis and SIRS.Design and setting A prospective, observational cohort study in a 22-bed PICU in a tertiary referral centre.Patients One hundred consecutive admissions to a PICU with at least one organ system failure longer than 12 h. Patients were classified into those with infectious or non-infectious insults as the primary reason for intensive care admission. Patients were followed to determine which developed sepsis or non-infection related SIRS using standard criteria.Measurements and results Of the 100 patients 50 had infectious and 50 had non-infectious insults as the precipitant for admission. 42 patients had variant MBL alleles (determined by MBL-2 gene exon 1 and promoter polymorphisms) and were significantly over-represented amongst the 59 patients that developed SIRS. This effect was not explained by differences in age, sex or ethnicity and was seen in both the infection and non-infection subgroups. In patients with infection, variant MBL alleles were associated with increased systemic response (2/15 with localised infection, 10/19 with sepsis and 12/16 with septic shock). MBL serum levels showed close concordance with the genotype and indicated that MBL levels less than 1000 ng/ml are associated with a greatly increased risk of SIRS.Conclusions MBL-2 exon 1 polymorphisms with low serum levels of functional MBL protein are associated with a greatly increased risk of developing SIRS and of progression from infection to sepsis and septic shock in paediatric ICU patients.M.T. and N.K. are scientific consultants for NatImmune, a Danish company exploring the therapeutic potential of MBL.An editorial regarding this article can be found in the same issue ()