Thrombin-activatable fibrinolysis inhibitor (TAFI) is enhanced in major trauma patients without infectious complications

• Published in: Immunobiology (1979) 2013-04, Vol.218 (4), p.470-476
• Main Authors: Relja, B, Lustenberger, T, Puttkammer, B, Jakob, H, Morser, J, Gabazza, E.C, Takei, Y, Marzi, I
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Advanced Basic Science; Aged; Aged, 80 and over; Allergy and Immunology; C-Reactive Protein - immunology; C-Reactive Protein - metabolism; Calcitonin - blood; Calcitonin - immunology; Calcitonin Gene-Related Peptide; Carboxypeptidase B2 - blood; Carboxypeptidase B2 - immunology; Coagulation; Female; Humans; Inflammation; Inflammation - blood; Inflammation - immunology; Inflammation Mediators - blood; Inflammation Mediators - immunology; Interleukin-6 - blood; Interleukin-6 - immunology; Leukocyte Count; Male; Middle Aged; Multiple Trauma - blood; Multiple Trauma - complications; Multiple Trauma - immunology; Pilot Projects; Pneumonia - blood; Pneumonia - etiology; Pneumonia - immunology; Protein Precursors - blood; Protein Precursors - immunology; Sepsis; Sepsis - blood; Sepsis - etiology; Sepsis - immunology; TAFI; Time Factors; Trauma
• ISSN: 0171-2985; 1878-3279
• DOI: 10.1016/j.imbio.2012.06.002

Abstract Background Infectious complications frequently occur after major trauma, leading to increased morbidity and mortality. Thrombin-activatable fibrinolysis inhibitor (TAFI), a procarboxypeptidase in plasma, plays a dual role in regulating both coagulation and inflammation. Activated TAFI (TAFIa) has broad anti-inflammatory properties due to its inactivation of active inflammatory mediators (anaphylatoxins C3a and C5a, bradykinin, osteopontin). Objectives The purpose of this study was to determine if TAFI plays a role in the development of inflammatory complications after major trauma. Patients/methods Upon arrival at the emergency department (ED), plasma levels of TAFI and TAFIa were measured in 26 multiple traumatized patients for 10 consecutive days. Systemic levels of inflammatory mediators, including interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and leukocytes were determined. Results Fifteen patients developed pneumonia and/or sepsis ( compl ) and 11 had no complications ( wo compl ). Overall injury severity and age were comparable in both groups. Complications occurred approximately 5 days after trauma. IL-6 increased on day 5, whereas CRP, PCT and leukocytes started to increase on day 6 in the compl -group. Upon arrival at the ED and on days 1 and 4, TAFI levels were significantly lower in the compl -group compared to the wo compl -group ( p = 0.0215). Similarly, TAFIa was significantly lower on day 4 in the compl -group than in the wo compl -group ( p = 0.049). Conclusions This pilot study shows that TAFI levels are inversely correlated with inflammation-associated development of complications after major trauma.