TY - JOUR
T1 - Elastase and granzymes during meningococcal disease in children: correlation to disease severity
AU - van Woensel, Job B. M.
AU - Biezeveld, Maarten H.
AU - Hack, C. Erik
AU - Bos, Albert P.
AU - Kuijpers, Taco W.
PY - 2005
Y1 - 2005
N2 - Objective: To investigate the levels of human neutrophil elastase and lymphocyte-derived granzymes A and B in relation to disease severity in children with meningococcal disease. Design: Clinical observational cohort study. Setting: Paediatric intensive care unit. Patients: All patients with meningococcal disease during the study period were included. Measurements and results: Blood sampling was done on the day of admission and on days 3 and 7. Assays for elastase and granzymes were done with ELISA. Sixty-one patients were included: 19 having distinct meningitis; 17 meningitis and shock; and 25 fulminant septicaemia. On admission levels of elastase were increased in all patients, being highest in those with fulminant septicaemia and lowest in those with distinct meningitis. Granzyme A (although marginally) and granzyme B levels were only increased in patients with shock. In 20 of the 28 patients admitted for >= 3 days elastase decreased from admission ("rapid-decrease" group). In the remaining 8 patients, elastase started to decrease after 2 days ("slow-decrease" group). Patients of the "slow-decrease" group had a higher temperature up to day 4, needed more respiratory support (mean airway pressure in cm H2O on days 3 and 4: p=0.02 and p <0.01, respectively), and more circulatory support (> 2 inotropic agents on day 3; p=0.04) compared with the "rapid-decrease" group. Conclusions: Human neutrophil elastase and granzyme B are related with disease severity during the initial phase of meningococcal disease and prolonged neutrophil activation is associated with the extent of organ dysfunction during the period thereafter
AB - Objective: To investigate the levels of human neutrophil elastase and lymphocyte-derived granzymes A and B in relation to disease severity in children with meningococcal disease. Design: Clinical observational cohort study. Setting: Paediatric intensive care unit. Patients: All patients with meningococcal disease during the study period were included. Measurements and results: Blood sampling was done on the day of admission and on days 3 and 7. Assays for elastase and granzymes were done with ELISA. Sixty-one patients were included: 19 having distinct meningitis; 17 meningitis and shock; and 25 fulminant septicaemia. On admission levels of elastase were increased in all patients, being highest in those with fulminant septicaemia and lowest in those with distinct meningitis. Granzyme A (although marginally) and granzyme B levels were only increased in patients with shock. In 20 of the 28 patients admitted for >= 3 days elastase decreased from admission ("rapid-decrease" group). In the remaining 8 patients, elastase started to decrease after 2 days ("slow-decrease" group). Patients of the "slow-decrease" group had a higher temperature up to day 4, needed more respiratory support (mean airway pressure in cm H2O on days 3 and 4: p=0.02 and p <0.01, respectively), and more circulatory support (> 2 inotropic agents on day 3; p=0.04) compared with the "rapid-decrease" group. Conclusions: Human neutrophil elastase and granzyme B are related with disease severity during the initial phase of meningococcal disease and prolonged neutrophil activation is associated with the extent of organ dysfunction during the period thereafter
U2 - https://doi.org/10.1007/s00134-005-2720-3
DO - https://doi.org/10.1007/s00134-005-2720-3
M3 - Article
C2 - 16010574
SN - 0342-4642
VL - 31
SP - 1239
EP - 1247
JO - Intensive care medicine
JF - Intensive care medicine
IS - 9
ER -
