PLATELET-ACTIVATING-FACTOR AND PHOSPHOLIPASE A(2) IN PATIENTS WITH SEPTIC SHOCK AND TRAUMA

Objective: To study blood and bronchoalveolar lavage (BAL) fluid level s of platelet activating factor (PAF-acether) and phospholipase A(2) ( PLA(2)) in patients with septic shock or following severe trauma. Desi gn: Prospective controlled clinical study. Setting: An intensive care unit (ICU) of a university hospital. Patients and participants: The st udy comprised 12 patients, 8 with septic shock and 4 with trauma, cons ecutively admitted to the ICU. Healthy volunteers were used as control s. Measurements and results: Blood PAF-acether and plasma PLA(2) level s were measured within 24 h after the patients arrival to the ICU. The Apache II score and outcome were registered. Median values for PAF-ac ether and PLA(2) in the septic shock patients were 10.5x10(-10) M and 5300 units/ml, respectively, whereas corresponding values in the traum a patients were 1.3x10(-10) M and 770 units/ml. Normal healthy individ uals had no detectable PAF-acether in the circulating blood (<0.5 x 10 (-10) M), and normal plasma PLA(2) activity was <300 units/ml. Moreove r, both PLA(2) and PAF-acether levels correlated well with the severit y of the disease as assessed by the Apache II scoring system (p<0.01 f or PLA(2) and p<0.05 for PAF-acether). In addition, PAF-acether and PL A(2) were determined in BAL fluid of patients with septic shock (n = 5 ) and trauma (pa = 3); increased PAF-acether levels were found in four patients with septic shock and one patient with trauma. Conclusion: T hese results demonstrate a significant increase of both PLA(2) and PAE -acether in the circulation of trauma patients, and a further increase in septic shock patients. It is possible that PAF-acether and PLA(2) can be used as markers for the severity of the disease in septic shock and following severe trauma.