Local fibrinolysis

Impact of Polytrauma and Acute Respiratory Distress Syndrome on Markers of Fibrinolysis: A Prospective Pilot Study

Acute respiratory distress syndrome (ARDS), which is associated with major morbidity and high mortality, is commonly developed by polytraumatized patients. Its pathogenesis is complex, and its development is difficult to anticipate, as candidate biomarkers for the prediction of ARDS were found not to be reliable for clinical use. In this prospective study, we assessed the serum antigen levels of tissue plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1) of 28 survivors of blunt polytrauma (age ≥18 years; injury severity score ≥16) at admission and on days 1, 3, 5, 7, 10, 14, and 21 of hospitalization. Our results show that these patients presented high mean tPA and PAI-1 antigen levels at admission; despite their decline, these parameters remained elevated for 3 weeks. Over this period, the mean tPA antigen level was higher in polytrauma victims suffering from ARDS than in those without ARDS, whereas the mean PAI-1 level was higher in polytrauma victims sustaining pneumonia than in those without pneumonia. Moreover, in each individual developing ARDS, the polytrauma-related elevated tPA antigen level either continued to rise after admission or suffered a second increase up to the onset of ARDS, declining immediately thereafter. Therefore, our findings support the assessment of serum tPA antigen levels after the initial treatment of polytraumatized patients, as this parameter shows potential as a biomarker for the development of ARDS and for the consequent identification of high-risk individuals.

[Determination of molecular genetic markers in acute coronary syndromes and their relationship to cardiovascular adverse events]

INTRODUCTION

The genes coding for proteins due to their activity in several metabolic pathways could be related with the onset of acute coronary syndromes.

OBJECTIVE

Relationship among polymorphisms and adverse events in.

METHODS

Prospective. In--hospital, one--year follow-up. Inclusion Acute coronary syndromes with ST elevation or depression secondary to atherothrombosis, clinical stability. In all, polymerase chain reaction and length polymorphism of restriction fragments. By standardizing chain reactions and genotyping,a preliminary analysis of distribution of genotypes was performed for each polymorphism and no deviations were observed in the law of Hardy-Weinberg equilibrium (P>.05).

RESULTS

From 2003 to 2005, 150 subjects were enrolled. We analyzed 14 polymorphisms in 9 genes (fibrinogen, factor v, vii, ii, xiii, plasminogen activator and inhibitor-1, C-reactive protein). In acute coronary syndromes, fibrinogen>450 mg/dL and white blood count 8500 cells/mm(3) were markers of poor prognosis to one year. Regression analysis identified the -148 CT/TT and fibrinogen -717 AG/GG of C-reactive protein as a marker of recurrent ischemia and reinfarction 1691GA + AA.

CONCLUSION

We are showing a relationship among polymorphisms involved in inflammation and hemostasis with adverse events in the acute phase and follow-up in acute coronary syndromes patients that could be considered as markers of ischemic heart disease. Larger sample is needed to confirm these results.