Abstract
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.
Highlights
Acute respiratory distress syndrome (ARDS) is a common complication in polytrauma victims, those with chest injuries, and a major cause of mortality and morbidity
Fibrinolysis is activated by the serine protease tissue plasminogen activator, which is secreted into the plasma as an active single-chain enzyme [9] primarily by vascular endothelial cells through two pathways: consecutive secretion, in which proteins are continuously released as fast as they are synthesized, resulting in a low steady output and stable level of active tPA [10]; and regulated secretion, in which newly synthesized tPA is stored at high concentrations in organelles and secreted only in response to an appropriate stimulus [11]
ARDS was diagnosed in individuals and pneumonia in
Summary
Acute respiratory distress syndrome (ARDS) is a common complication in polytrauma victims, those with chest injuries, and a major cause of mortality and morbidity. Ozolina et al [30] assessed the plasma concentrations of coagulation and fibrinolysis markers (tissue factor, tPA, and PAI-1) in ARDS and non-ARDS patients of mixed etiologies at enrollment and at the third and seventh days of intensive care They found increased levels of tissue factor and PAI-1 antigen at the seventh day in patients diagnosed with ARDS, indicating a supportive diagnostic role for these biomarkers. The objectives of this study were to compare the individual and mean time courses of tPA and PAI-1 differences in curve progression between subgroups that combine patients developing/not developing ARDS and sustaining/not sustaining pneumonia in order to determine their predictive value for the development of these complications. Intergroup differences in biomarker levels not reaching statistical significance are indicated by NS (not significant) without specifying the p-value
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