PLASMINOGEN - AN IMPORTANT HEMOSTATIC PARAMETER IN SEPTIC PATIENTS

Background: Previously we observed in some but not all septic patients a low plasma concentration of plasminogen. Objectives: To investigate prospectively whether plasma levels of plasminogen or the ratio of pl asminogen to alpha-2-antiplasmin have a prognostic value for survival from sepsis and to study the variation of other hemostatic parameters during septicemia. Patients: The study population consisted of 45 cons ecutive patients with septicemia, 15 non-septic patients from the same intensive care unit and 30 healthy volunteers. Measurements and Main Results: Plasminogen concentrations were significantly lower (p <0.001 ) in plasma of septic patients (median 0,62 IU/ml range: 0.15-1,06) th an in plasma of healthy controls (median 1.00 IU/ml, range: 0.75-1.10) or of non-septic intensive care patients (median 1.00 IU/ml, range: 0 .82-1.08). Among the other parameters tested, plasminogen activator in hibitor (PAI-1) antigen concentration and PAI activity were similar in septic and non-septic intensive care patients, but higher than in hea lthy controls. Concentrations of elastase-alpha-1-protease inhibitor o r of thrombin-antithrombin complexes were higher in septic patients th an in non-septic intensive care patients or healthy controls. A degrad ed form of plasminogen of 38 kDa was detected by Western blot analysis in the plasma of septic patients, but not in plasma of non-septic int ensive care patients or controls. Plasminogen alone or the ratio of pl asminogen to antiplasmin were good markers for survival from septicemi a. E.g. for plasminogen at a cut off of 0.65 IU/ml, sensitivity was 90 .5% and specificity 66.7%, whereas for the ratio of plasminogen over a ntiplasmin at a cut off ratio of 0,65 IU/ml, sensitivity was 95.2% and specificity 70.8%. Conclusion: Plasminogen or the ratio of plasminoge n to antiplasmin are sensitive markers for survival in patients with s epticemia.