Use Of Chromogenic Peptide Substrate Assays In The Evaluation Of Surgical Treatment Of Intraabdominal Sepsis

Abstract

Chromogenic peptide substrate assays were included in the evaluation program of 14 patients having surgical treatment for intraabdominal sepsis.Six of the patients survived, whereas eight died. The six survivors had a total of 19 operations (1-5 operations /patient). The eight fatal cases had a total of 14 operations (1-2 operations/patient). Plasma prekallikrein (PKK), functional antikallikrein (KKI), plasminogen (Pig), fast antiplasmin (AP) and functional antithrombin III (AT- III) values were determined using chromogenic peptide substrate assays. Hageman factor levels (HF) were determined using a coagulation assay with a HF deficient plasma. α2-Antiplasmin (α2AP), CI-esterase inhibitor (CIINH), α2- Macroglobulin (α2M) and AT III were determined immunochemically.In both the fatal cases and the survivors PKK, HF, Plg and AT III values were found markedly reduced during sepsis. The reductions of PKK and AT III were significantly more pronounced in the fatal cases than in the survivors. During sepsis the ratio of functional activity versus immunochemical values decreased when compared with normals for α2AP, CIINH and AT III. Whereas the parameters remained reduced in the fatal cases, gradual increases towards normal values for PKK, HF, Plg and AT III were found within two weeks in the survivors. Clinically and by autopsy all the fatal cases were evaluated to have a persistant intraabdominal septic focus.It is concluded that chromogenic peptide substrate assays appear to be of great value in evaluating surgical treatment of intraabdominal sepsis.