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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
  • 756 Downloads

Keywords

Acute Phase Protein Chromogenic Substrate Proinflammatory Mediator Antigenic Level Fatal Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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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