Significance of the PAP complex in thermal injury

Plasmin-antiplasmin complex (PAP) has been reported previously as elevated in sepsis syndrome and infection. To assess the value of PAP complex and the thrombin-antithrombin (TAT)/PAP ratio in thermal injury, sixty patients were studied within the first 36 h, at 5-7 days following injury, and at time of infection. The patient population was categorized by percent burn (2 degrees + 3 degrees): <20%, n = 22; 20-40%, n = 18; >40%, n = 20. PAP increased significantly between days 1 and 5 in the <20% and 20-40% burn groups (p < 0.01) and in the >40% group (p < 0.002). The TAT/PAP ratio was elevated on day 1 in the 20-40% group (p < 0.04) and the >40% group (p < 0.001), and decreased to near normal limits on day 5 in both groups. These data revealed a proportionately greater incidence of coagulation activation than fibrinolysis on day 1. Of 16 episodes of sepsis syndrome or severe infection, PAP was elevated, average 14.6 nM (normal <8 nM), in 10 (63%) patients. PAP was significantly elevated on day 5 during the clinically stabilized phase regardless of percent burn (p = 0.01). In individuals who had a burn wound surface area of >40%, the PAP values were significantly higher for those who did not survive (p < 0.03). PAP did not appear to correlate with the type of burn or with inhalation. Although PAP complex levels were elevated in thermal injury patients with sepsis syndrome or severe infection, they were not a specific predictor of infection. In conclusion, PAP complex and the TAT/PAP ratio provided useful information as to the fibrinolytic status of thermally injured patients with correlation to survival, but without correlation to sepsis and infection.