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Plasma kallistatin levels in patients with severe community-acquired pneumonia

Wei-Chieh Lin1*, Shiou-Ling Lu2, Chiou-Feng Lin34, Chang-Wen Chen1, Lee Chao5, Julie Chao5 and Yee-Shin Lin46

Author Affiliations

1 Medical Intensive Care Unit, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, Tainan 70101, Taiwan

2 Institute of Basic Medical Sciences, National Cheng Kung University Medical College, Tainan 70101, Taiwan

3 Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan 70101, Taiwan

4 Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan 70101, Taiwan

5 Department of Biochemistry and Molecular Biology, Medical University of South Carolina, Charleston, South Carolina 29425, USA

6 Department of Microbiology and Immunology, National Cheng Kung University Medical College, Tainan 70101, Taiwan

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Critical Care 2013, 17:R27  doi:10.1186/cc12507

Published: 8 February 2013



Community-acquired pneumonia (CAP) requiring intensive care unit (ICU) treatment commonly causes acute respiratory failure with high mortality. Kallistatin, an endogenous tissue kallikrein inhibitor, has been reported to be protective in various human diseases. The aim of this study was to assess the correlations of kallistatin with other biomarkers and to determine whether kallistatin levels have a prognostic value in severe CAP.


Plasma samples and clinical data were prospectively collected from 54 patients with severe CAP requiring ICU admission. Seventeen healthy control subjects were included for comparison. Plasma kallistatin, kallikrein, and other biomarkers of inflammation (tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, C-reactive protein (CRP)), and anti-coagulation (protein C, anti-thrombin III) were measured on days 1 and 4 of ICU admission. Comparison between survivors (n = 41) and nonsurvivors (n = 13) was performed.


Plasma kallistatin was significantly consumed in severe CAP patients compared with healthy individuals. Lower day 1 kallistatin levels showed a strong trend toward increased mortality (P = 0.018) and higher day 1 CURB-65 scores (P = 0.004). Plasma kallistatin levels on day 1 of ICU admission were significantly decreased in patients who developed septic shock (P = 0.017) and who had acute respiratory distress syndrome (P = 0.044). In addition, kallistatin levels were positively correlated with anti-thrombin III and protein C and inversely correlated with IL-1β, IL-6, and CRP levels. In a multivariate logistic regression analysis, higher day 1 CURB-65 scores were independent predictors of mortality (odds ratio = 29.9; P = 0.009). Also, higher day 1 kallistatin levels were independently associated with a decreased risk of death (odds ratio, 0.1) with a nearly significant statistical difference (P = 0.056). Furthermore, we found that a cutoff level of 6.5 μg/ml of day 1 kallistatin determined by receiver operating characteristic curves could be used to distinguish between patients who survived in 60 days and those who did not.


These results suggest that kallistatin may serve as a novel marker for severe CAP prognosis and may be involved in the pathogenesis of CAP through antiinflammatory and anticoagulation effects.

See related letter by Katz et al., webcite