Plasma Fibronectin and Associated Variables in Surgical Intensive Care Patients

Abstract

An acute depletion of plasma fibronectin (FN) has been observed in critically ill, surgical or trauma patients but there is little information on the relationships between FN levels and the final outcome in such cases, and on the simultaneous behavior of other serum proteins. The daily values of FN, antithrombin [AT] III, IgG, C3 [complement component 3], prealbumin and transferrin were monitored in 98 intensive care patients after major elective surgery or trauma. According to their clinical course, they were divided retrospectively into three groups. Group A (33 patients) had sepsis, group B (31 patients) had nonseptic complications and group C (34 patients) had no complications in the ICU. The individual, nadir levels of FN, AT III, prealbumin and transferrin were lower (P < 0.01) in the septic group A than in B and C. Within the septic group, the nadir levels of AT III, but not those of FN, were lower (P < 0.01) in the 14 nonsurvivors than in the 19 survivors. The FN and AT III levels had returned, at least temporarily, to the normal range in the 6 ultimate fatalities from sepsis who survived for more than 2 wk. In the septic group, transferrin showed the highest percentages of actually subnormal levels and differed from FN in this respect with P < 0.05. All 6 proteins showed a significant overall pattern (P < 0.01) of parallel variations. The results confirm other reports on the behavior of fibronectin in septic patients as a group, but it was not informative as to the individual outcome, and its reduction might be viewed as part of a general plasma protein depletion associated with acute septic disease. This pattern is probably attributable to a combination of intravascular consumption and an overall excess of protein catabolism over synthesis.