Plasma kallistatin levels in patients with severe community-acquired pneumonia

Wei Chieh Lin, Shiou Ling Lu, Chiou Feng Lin, Chang Wen Chen, Lee Chao, Julie Chao, Yee Shin Lin

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Introduction: Community-acquired pneumonia (CAP) requiring intensive care unit (ICU) treatment commonly causes acute respiratory failure with high mortality. Kallistatin, an endogenous tissue kallikrein inhibitor, has been reported to be protective in various human diseases. The aim of this study was to assess the correlations of kallistatin with other biomarkers and to determine whether kallistatin levels have a prognostic value in severe CAP.Methods: Plasma samples and clinical data were prospectively collected from 54 patients with severe CAP requiring ICU admission. Seventeen healthy control subjects were included for comparison. Plasma kallistatin, kallikrein, and other biomarkers of inflammation (tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, C-reactive protein (CRP)), and anti-coagulation (protein C, anti-thrombin III) were measured on days 1 and 4 of ICU admission. Comparison between survivors (n = 41) and nonsurvivors (n = 13) was performed.Results: Plasma kallistatin was significantly consumed in severe CAP patients compared with healthy individuals. Lower day 1 kallistatin levels showed a strong trend toward increased mortality (P = 0.018) and higher day 1 CURB-65 scores (P = 0.004). Plasma kallistatin levels on day 1 of ICU admission were significantly decreased in patients who developed septic shock (P = 0.017) and who had acute respiratory distress syndrome (P = 0.044). In addition, kallistatin levels were positively correlated with anti-thrombin III and protein C and inversely correlated with IL-1β, IL-6, and CRP levels. In a multivariate logistic regression analysis, higher day 1 CURB-65 scores were independent predictors of mortality (odds ratio = 29.9; P = 0.009). Also, higher day 1 kallistatin levels were independently associated with a decreased risk of death (odds ratio, 0.1) with a nearly significant statistical difference (P = 0.056). Furthermore, we found that a cutoff level of 6.5 μg/ml of day 1 kallistatin determined by receiver operating characteristic curves could be used to distinguish between patients who survived in 60 days and those who did not.Conclusions: These results suggest that kallistatin may serve as a novel marker for severe CAP prognosis and may be involved in the pathogenesis of CAP through antiinflammatory and anticoagulation effects.

Original languageEnglish
Article numberR27
JournalCritical Care
Volume17
Issue number1
DOIs
Publication statusPublished - Feb 8 2013
Externally publishedYes

Fingerprint

Pneumonia
Intensive Care Units
Protein C
Interleukin-1
Thrombin
C-Reactive Protein
Mortality
Interleukin-6
kallistatin
Biomarkers
Odds Ratio
Plasma Kallikrein
Tissue Kallikreins
Adult Respiratory Distress Syndrome
Septic Shock
Interleukin-8
ROC Curve
Respiratory Insufficiency
Survivors
Healthy Volunteers

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Lin, W. C., Lu, S. L., Lin, C. F., Chen, C. W., Chao, L., Chao, J., & Lin, Y. S. (2013). Plasma kallistatin levels in patients with severe community-acquired pneumonia. Critical Care, 17(1), [R27]. https://doi.org/10.1186/cc12507

Plasma kallistatin levels in patients with severe community-acquired pneumonia. / Lin, Wei Chieh; Lu, Shiou Ling; Lin, Chiou Feng; Chen, Chang Wen; Chao, Lee; Chao, Julie; Lin, Yee Shin.

In: Critical Care, Vol. 17, No. 1, R27, 08.02.2013.

Research output: Contribution to journalArticle

Lin, Wei Chieh ; Lu, Shiou Ling ; Lin, Chiou Feng ; Chen, Chang Wen ; Chao, Lee ; Chao, Julie ; Lin, Yee Shin. / Plasma kallistatin levels in patients with severe community-acquired pneumonia. In: Critical Care. 2013 ; Vol. 17, No. 1.
@article{04e098b8399240d5abb4ae1c8fc9dfb4,
title = "Plasma kallistatin levels in patients with severe community-acquired pneumonia",
abstract = "Introduction: Community-acquired pneumonia (CAP) requiring intensive care unit (ICU) treatment commonly causes acute respiratory failure with high mortality. Kallistatin, an endogenous tissue kallikrein inhibitor, has been reported to be protective in various human diseases. The aim of this study was to assess the correlations of kallistatin with other biomarkers and to determine whether kallistatin levels have a prognostic value in severe CAP.Methods: Plasma samples and clinical data were prospectively collected from 54 patients with severe CAP requiring ICU admission. Seventeen healthy control subjects were included for comparison. Plasma kallistatin, kallikrein, and other biomarkers of inflammation (tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, C-reactive protein (CRP)), and anti-coagulation (protein C, anti-thrombin III) were measured on days 1 and 4 of ICU admission. Comparison between survivors (n = 41) and nonsurvivors (n = 13) was performed.Results: Plasma kallistatin was significantly consumed in severe CAP patients compared with healthy individuals. Lower day 1 kallistatin levels showed a strong trend toward increased mortality (P = 0.018) and higher day 1 CURB-65 scores (P = 0.004). Plasma kallistatin levels on day 1 of ICU admission were significantly decreased in patients who developed septic shock (P = 0.017) and who had acute respiratory distress syndrome (P = 0.044). In addition, kallistatin levels were positively correlated with anti-thrombin III and protein C and inversely correlated with IL-1β, IL-6, and CRP levels. In a multivariate logistic regression analysis, higher day 1 CURB-65 scores were independent predictors of mortality (odds ratio = 29.9; P = 0.009). Also, higher day 1 kallistatin levels were independently associated with a decreased risk of death (odds ratio, 0.1) with a nearly significant statistical difference (P = 0.056). Furthermore, we found that a cutoff level of 6.5 μg/ml of day 1 kallistatin determined by receiver operating characteristic curves could be used to distinguish between patients who survived in 60 days and those who did not.Conclusions: These results suggest that kallistatin may serve as a novel marker for severe CAP prognosis and may be involved in the pathogenesis of CAP through antiinflammatory and anticoagulation effects.",
author = "Lin, {Wei Chieh} and Lu, {Shiou Ling} and Lin, {Chiou Feng} and Chen, {Chang Wen} and Lee Chao and Julie Chao and Lin, {Yee Shin}",
year = "2013",
month = "2",
day = "8",
doi = "10.1186/cc12507",
language = "English",
volume = "17",
journal = "Critical Care",
issn = "1466-609X",
publisher = "Springer Science + Business Media",
number = "1",

}

TY - JOUR

T1 - Plasma kallistatin levels in patients with severe community-acquired pneumonia

AU - Lin, Wei Chieh

AU - Lu, Shiou Ling

AU - Lin, Chiou Feng

AU - Chen, Chang Wen

AU - Chao, Lee

AU - Chao, Julie

AU - Lin, Yee Shin

PY - 2013/2/8

Y1 - 2013/2/8

N2 - Introduction: Community-acquired pneumonia (CAP) requiring intensive care unit (ICU) treatment commonly causes acute respiratory failure with high mortality. Kallistatin, an endogenous tissue kallikrein inhibitor, has been reported to be protective in various human diseases. The aim of this study was to assess the correlations of kallistatin with other biomarkers and to determine whether kallistatin levels have a prognostic value in severe CAP.Methods: Plasma samples and clinical data were prospectively collected from 54 patients with severe CAP requiring ICU admission. Seventeen healthy control subjects were included for comparison. Plasma kallistatin, kallikrein, and other biomarkers of inflammation (tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, C-reactive protein (CRP)), and anti-coagulation (protein C, anti-thrombin III) were measured on days 1 and 4 of ICU admission. Comparison between survivors (n = 41) and nonsurvivors (n = 13) was performed.Results: Plasma kallistatin was significantly consumed in severe CAP patients compared with healthy individuals. Lower day 1 kallistatin levels showed a strong trend toward increased mortality (P = 0.018) and higher day 1 CURB-65 scores (P = 0.004). Plasma kallistatin levels on day 1 of ICU admission were significantly decreased in patients who developed septic shock (P = 0.017) and who had acute respiratory distress syndrome (P = 0.044). In addition, kallistatin levels were positively correlated with anti-thrombin III and protein C and inversely correlated with IL-1β, IL-6, and CRP levels. In a multivariate logistic regression analysis, higher day 1 CURB-65 scores were independent predictors of mortality (odds ratio = 29.9; P = 0.009). Also, higher day 1 kallistatin levels were independently associated with a decreased risk of death (odds ratio, 0.1) with a nearly significant statistical difference (P = 0.056). Furthermore, we found that a cutoff level of 6.5 μg/ml of day 1 kallistatin determined by receiver operating characteristic curves could be used to distinguish between patients who survived in 60 days and those who did not.Conclusions: These results suggest that kallistatin may serve as a novel marker for severe CAP prognosis and may be involved in the pathogenesis of CAP through antiinflammatory and anticoagulation effects.

AB - Introduction: Community-acquired pneumonia (CAP) requiring intensive care unit (ICU) treatment commonly causes acute respiratory failure with high mortality. Kallistatin, an endogenous tissue kallikrein inhibitor, has been reported to be protective in various human diseases. The aim of this study was to assess the correlations of kallistatin with other biomarkers and to determine whether kallistatin levels have a prognostic value in severe CAP.Methods: Plasma samples and clinical data were prospectively collected from 54 patients with severe CAP requiring ICU admission. Seventeen healthy control subjects were included for comparison. Plasma kallistatin, kallikrein, and other biomarkers of inflammation (tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, C-reactive protein (CRP)), and anti-coagulation (protein C, anti-thrombin III) were measured on days 1 and 4 of ICU admission. Comparison between survivors (n = 41) and nonsurvivors (n = 13) was performed.Results: Plasma kallistatin was significantly consumed in severe CAP patients compared with healthy individuals. Lower day 1 kallistatin levels showed a strong trend toward increased mortality (P = 0.018) and higher day 1 CURB-65 scores (P = 0.004). Plasma kallistatin levels on day 1 of ICU admission were significantly decreased in patients who developed septic shock (P = 0.017) and who had acute respiratory distress syndrome (P = 0.044). In addition, kallistatin levels were positively correlated with anti-thrombin III and protein C and inversely correlated with IL-1β, IL-6, and CRP levels. In a multivariate logistic regression analysis, higher day 1 CURB-65 scores were independent predictors of mortality (odds ratio = 29.9; P = 0.009). Also, higher day 1 kallistatin levels were independently associated with a decreased risk of death (odds ratio, 0.1) with a nearly significant statistical difference (P = 0.056). Furthermore, we found that a cutoff level of 6.5 μg/ml of day 1 kallistatin determined by receiver operating characteristic curves could be used to distinguish between patients who survived in 60 days and those who did not.Conclusions: These results suggest that kallistatin may serve as a novel marker for severe CAP prognosis and may be involved in the pathogenesis of CAP through antiinflammatory and anticoagulation effects.

UR - http://www.scopus.com/inward/record.url?scp=84873468060&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84873468060&partnerID=8YFLogxK

U2 - 10.1186/cc12507

DO - 10.1186/cc12507

M3 - Article

VL - 17

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 1

M1 - R27

ER -