Critical Care

, 3:P081 | Cite as

The perioperative course of C1-esterase-inhibitor: evidence for an early deficiency

  • M Cobas Meyer
  • G Marx
  • B Vangerow
  • J Heine
  • M Leuwer
  • S Piepenbrock
  • H Rueckoldt
Meeting abstract
  • 734 Downloads

Keywords

Acute Phase Protein Chromogenic Substrate Proinflammatory Mediator Antigenic Level Fatal Complication 

Objective

Since the extent of complement-and contact-activation and a low functional index of their main inactivator C1-esterase-inhibitor (C1-INH) are related to outcome in sepsis, a relative deficiency of C1-INH might contribute to the development of fatal complications. At present few data on the periperative course of C1-INH plasma levels have been published. In our study the early perioperative course of C1-INH in relation to the acute phase protein interleukin-6 (IL-6) was investigated in order to assess one possible important aspect of the balance between anti-and proinflammatory mediators.

Methods

In 19 consecutive patients undergoing elective oropharynx tumorresection functional C1-INH was measured by chromogenic substrate assay Berichrom® C1-Inactivator, the total quantity by single radial imunodiffusion assay NOR-Partigen® and cytokine IL-6 levels by MEDGENIX IL-6-45 MIN-EASIA. Samples were taken before operation (tl), on ICU admission (t2) and on the first postoperative day (t3).

Results

The mean operation time was 9 h (range: 4:05 to 14:40 h) and all patients showed an uncomplicated ICU course up to 86 h. IL-6 levels increased from t1 to t2 (P < 0.01), whereas C1-INH functional levels declined tendencially and antigenic levels dropped (P = 0.024). Levels of C1-INH at t3 returned to preoperative values and IL-6 declined.

Conclusion

As expected (postoperative agression syndrome) IL-6 increased significantly. Surprisingly, plasma levels of the anti-inflammatory acute phase protein C1-INH remained normal or even declined. On the first postoperative day C1-INH and IL-6 levels tended to return to preoperative values. This was associated with uncomplicated clinical course. We suggest, that this short period of disproportion between pro- and anti-inflammatory mediators may increase the `second hit' risk, if it is longer lasting.

Table

Mean± sd

t1

t2

t3

C1-Inh, functional (%)

105 ± 20

92 ± 20

 102 ± 24.7

C1 -Inh, antigenic (mg/l)

105 ± 29

87 ± 18

98 ± 28

IL-6 (pg/ml)

  52 ± 84

326 ± 380

192 ± 133

Copyright information

© Current Science Ltd 1999

Authors and Affiliations

  • M Cobas Meyer
    • 1
  • G Marx
    • 1
  • B Vangerow
    • 1
  • J Heine
    • 1
  • M Leuwer
    • 1
  • S Piepenbrock
    • 1
  • H Rueckoldt
    • 1
  1. 1.Dept. of AnaesthesiologyHannover Medical SchoolHannoverGermany

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