Changes in Mannose-Binding Lectin and Collectin Kidney 1 Levels in Sepsis Patients With and Without Disseminated Intravascular Coagulation

Abstract

In sepsis, systemic coagulation activation frequently causes disseminated intravascular coagulation (DIC), and the uncontrolled activation of the complement system can induce multiple organ dysfunction and poor prognosis. This study aimed to examine the association of DIC with levels of collectin kidney 1 (CL-K1), a novel collectin of the complement system, and mannose-binding lectin (MBL), a classical-type collectin in patients with sepsis. We collected blood samples prospectively from adult patients with sepsis admitted to the intensive care unit (ICU) from day 1 (admission) to day 5. The CL-K1 and MBL levels were measured by enzyme-linked immunosorbent assay, and DIC was diagnosed by using a scoring algorithm. The correlation of CL-K1 and MBL levels with other coagulation markers was analyzed. There were 37 patients with DIC (DIC group) and 15 without DIC (non-DIC group). Compared to the non-DIC group, the DIC group had more severe conditions and higher mortality. During the 5 days after ICU admission, plasma CL-K1 levels were similar between the groups, but plasma MBL levels were significantly lower in the DIC group. Plasma CL-K1 levels were weakly correlated with prothrombin time, activated partial thromboplastin time, and antithrombin levels; plasma MBL levels were weakly correlated with fibrin/fibrinogen degradation product levels and DIC score. In conclusion, during the first 5 days of ICU admission, plasma CL-K1 levels were similar between the DIC and non-DIC groups. However, plasma MBL levels were lower in the DIC group compared to the non-DIC group, and the significance of this difference grew gradually over time.

Keywords: collectin; complement system proteins; disseminated intravascular coagulation; mannose-binding lectin; sepsis.

Figure 1.

The plasma levels of CL-K1 in the DIC and non-DIC groups. Data are presented as box and whisker plots. The plasma levels of CL-K1 are not significantly different between the 2 groups. (Normal range 0.34 ± 0.13 μg/mL, as presented by a gray band in the figure). P < .017 is considered statistically significant after Bonferroni correction. CL-K1 indicates collectin kidney 1; DIC, disseminated intravascular coagulation. Gray denotes DIC group; white denotes non-DIC group.

Figure 2.

The plasma levels of MBL in the DIC and non-DIC groups. Data are presented as box and whisker plots. The plasma levels of MBL are statistically different between the 2 groups on days 1, 3, and 5 after ICU admission. (Normal range 1.72 ± 1.51 μg/mL, as presented by a gray band in the figure). P < .017 is considered statistically significant after Bonferroni correction. MBL indicates mannose-binding lectin; DIC, disseminated intravascular coagulation; gray, DIC group; ICU, intensive care unit. White denotes non-DIC group.

Figure 3.

Differences in hepatic function–related markers between the DIC and non-DIC groups. Data are presented as box and whisker plots. The total bilirubin levels were statistically different between the 2 groups on days 2, 3, and 4 after ICU admission. There was no statistically significant difference between the 2 groups for the other variables. P < .01 is statistically significant after Bonferroni correction. ALT indicates alanine aminotransferase; AST, aspartate aminotransferase; DIC, disseminated intravascular coagulation; ICU, intensive care unit. Gray denotes DIC group; white denotes non-DIC group.