Elastase and granzymes during meningococcal disease in children: correlation to disease severity.

Abstract

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 > or = 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.

• Authors: Job B M van Woensel, Maarten H Biezeveld, C Erik Hack, Albert P Bos, Taco W Kuijpers
• Journal: Intensive care medicine (Intensive Care Med) Vol. 31 Issue 9 Pg. 1239-47 (Sep 2005) ISSN: 0342-4642 [Print] United States
• PMID: 16010574 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• GZMB protein, human
• Granzymes
• Serine Endopeptidases
• Leukocyte Elastase
• GZMA protein, human

Topics

• Child
• Child, Preschool
• Enzyme-Linked Immunosorbent Assay
• Female
• Granzymes
• Humans
• Intensive Care Units, Pediatric
• Leukocyte Elastase (blood)
• Male
• Meningococcal Infections (classification, enzymology)
• Prospective Studies
• Serine Endopeptidases (blood)
• Severity of Illness Index