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American Journal of Pathology, Vol 140, 897-906, Copyright © 1992 by American Society for Investigative Pathology
REGULAR ARTICLES |
RA Pixley, RA DeLa Cadena, JD Page, N Kaufman, EG Wyshock, RW Colman, A Chang and FB Taylor Jr
Thrombosis Research Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19140.
The hypotension in septicemia is believed to be mediated by the combined action of many mediators including cytokines, prostaglandins, and complement components. To evaluate the contribution of the contact/kinin-forming system to hypotension, the authors used an established experimental baboon model of bacteremia in which two concentrations of Escherichia Coli (E. coli) were used to produce lethal and nonlethal hypotension. The lethal group (n = 5) developed irreversible hypotension that significantly correlated with the decline in levels of high molecular weight kininogen (HK) and an increase in alpha 2 macroglobulin-kallikrein complexes (alpha 2M-kal). The nonlethal group (n = 9) experienced reversible hypotension, a less striking decline in HK, and only slight elevation in alpha 2M-kal. No significant changes were found in levels of factor XII, prekallikrein, and factor XI in either group. A significant change in the contact system, which reflects the fatal outcome, is the rise in alpha 2M-kal. This study suggests that irreversible hypotension correlates with prolonged activation of the contact system.
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