Plasma neutrophil elastase correlates with pulmonary vascular permeability: A prospective observational study in patients with pneumonia

Takashi Tagami, Shigeki Kushimoto, Ryoichi Tosa, Mariko Omura, Kohei Yonezawa, Go Akiyama, Hisao Hirama, Hiroyuki Yokota

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)

Abstract

Background and objective: Little is known about plasma neutrophil elastase (PNE) levels in patients with community-acquired pneumonia (CAP) requiring treatment in the intensive care unit (ICU) or high care unit (HCU). In addition, the influence of PNE on pulmonary vascular permeability in a clinical setting has not been investigated. The aims of this study were (i) to investigate PNE levels in patients with CAP and (ii) to explore the relationship between PNE and pulmonary vascular permeability. Methods: Fourteen consecutive CAP patients who were admitted to the HCU (n = 8) or ICU (n = 6) were prospectively investigated over a 6-month period. A group of eight patients with hydrostatic pulmonary oedema without CAP served as a control group (CG). PNE levels were measured at regular intervals. The pulmonary vascular permeability index (PVPI) was monitored in all ICU and CG patients, using the PiCCO system. Results: PNE levels were higher in the CAP patients (132 (84-261) ng/mL) than in the CG patients (77 (64-107) ng/mL) (P = 0.04), and were highest in the ICU patients (186 (75-466) ng/mL). The PVPI was higher in the ICU patients (2.85 (1.90-4.00)) than in the CG patients (1.15 (0.75-2.35)) (P = 0.02). PNE levels correlated with PVPI in the ICU patients (r = 0.81, P < 0.001) but there was no correlation among the CG patients (r = 0.14, P = 0.73). Conclusions: Patients with severe CAP had high levels of PNE, which was closely correlated with PVPI. PNE may be involved in the pathogenesis of severe pneumonia. There was a significant correlation between plasma elastase levels and pulmonary vascular permeability, as measured by the single thermodilution technique using the PiCCO system, in patients with pneumonia who are at risk of ARDS.

Original languageEnglish
Pages (from-to)953-958
Number of pages6
JournalRespirology
Volume16
Issue number6
DOIs
Publication statusPublished - 2011 Aug

Keywords

  • acute respiratory distress syndrome
  • capillary permeability
  • extravascular lung water
  • neutrophil elastase
  • pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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