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Thromb Haemost 2009; 101(02): 239-247
DOI: 10.1160/TH08-03-0161
Theme Issue Article
Schattauer GmbH

Variations in the ratio between von Willebrand factor and its cleaving protease during systemic inflammation and association with severity and prognosis of organ failure

Ralf A. Claus
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
,
Clemens L. Bockmeyer   *
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
,
Ulrich Budde
2   AescuLabor Hamburg, Institute for Laboratory Medicine, Hamburg, Germany
,
Karim Kentouche
3   Department of Pediatrics, University Hospital, Friedrich-Schiller-University, Jena, Germany
,
Maik Sossdorf
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
4   Department of Sports Medicine, Friedrich-Schiller-University Jena, Germany
,
Thomas Hilberg
4   Department of Sports Medicine, Friedrich-Schiller-University Jena, Germany
,
Reinhart Schneppenheim
5   Children‘s University Hospital Hamburg-Eppendorf, Department of Pediatric Hematology and Oncology, Germany
,
Konrad Reinhart
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
,
Michael Bauer
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
,
Frank M. Brunkhorst
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
,
Wolfgang Lösche
1   Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Friedrich-Schiller-University, Jena, Germany
› Author AffiliationsFinancial support: The study was supported in part by a grant from the Thuringian Ministry of Science and Arts (TMWFK, project B-309–00014), by the Centre for Clinical Research Jena (IZKF), subproject 4.8 (Thrombotic Microangiopathy in sepsis) and by Deutsche Forschungsgemeinschaft (CL 173/4–1). CLB has received financial support from the ‘Förderverein’ Friedrich-Schiller University Jena (Loder-Grant for young investigators).
Further Information

Publication History

Received: 13 March 2008

Accepted after major revision: 25 January 2008

Publication Date:
23 November 2017 (online)

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Summary

Von Willebrand factor (VWF) and related parameters as well as the protease activity regulating its biological activity were measured in plasma of healthy controls and patients with different cause and severity of systemic inflammation to examine the efficacy of the measures to detect highly prothrombotic states including thrombotic microangiopathy (TMA), one of the sequelae of sepsis. Plasma levels of VWF increased with increasing severity of systemic inflammation, probably due to activation of the endothelium. In parallel, the proteolytic activity of VWF inactivating protease, ADAMTS13, stepwise declined with the severity of inflammation, emphasizing the role of VWF-triggered platelet aggregation on the endothelium subsequently followed by development of TMA. As a consequence, the ratio of VWF antigen level and ADAMTS13 activity was significantly higher in patients with inflammation and sepsis, suggesting that this ratio might be more useful for the diagnosis of highly prothrombotic states including TMA than VWF multimer analysis alone. These findings suggest that ADAMTS13, VWF and related parameters, even in a combined approach, might be useful for the diagnosis and the therapeutic monitoring of patients with sepsis associated thrombotic microangiopathy.

Keywords

ADAMTS13 - sepsis - systemic inflammation - organ failure - platelets - thrombotic microangiopathy - TMA-index

* Present address: Institute for Pathology, Hannover Medical School, Germany.


 

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