HEMOSTATIC COMPETENCE AND ELASTASE-ALPHA(1)-PROTEINASE INHIBITOR LEVELS IN SURGERY, TRAUMA, AND SEPSIS

Previous studies investigated the effects of neutrophil elastase on is olated factors in the hemostatic process. Some of these reported effec ts are, however, procoagulative and others anticoagulative. The aim of this study was to ascertain the effect of elastase on the in vivo hem ostatic competency. The effect of elastase activity on the hemostatic competency was determined in a group of 50 surgical intensive care uni t patients and 23 control subjects. Surgical intensive care unit patie nts were subgrouped into a surgery, a trauma, and a sepsis-multiple or gan failure group. Elastase activity was assessed by elastase-alpha(1) -proteinase inhibitor levels and hemostatic competency by thromboelast ography, Thromboelastography results showed a relativety normal coagul ative ability in the surgery group, a varying degree of thromboelastog raphic hypocoagulability in the trauma group, and pronounced thromboel astographic instability in the sepsis-multiple organ failure group. In creases in elastase-alpha(1)-proteinase inhibitor levels up to 200 mu g/L were accompanied by a compromised coagulative ability as seen in a prolongation of both the first and second phases of the clotting time , as well as a decrease in the maximal clot elasticity.