Components of the increased circulating proteolytic activity in pediatric burn patients.

Total proteolytic activity (PA) is increased in the circulation of pediatric burn patients. The extent of the increase correlates with the percent total body surface area (TBSA) burned and is associated with increased susceptibility to fatal infection. To determine the source or sources of this PA, three factors were evaluated: (1) levels of proteinase inhibitors--antithrombin, alpha 2-antiplasmin, and alpha 1-proteinase inhibitor; (2) levels of proteinase--neutrophil elastase; and (3) activation of circulating proteolytic cascade systems as indicated by changes in levels of system components--plasminogen and prekallikrein. All assays measured functional levels of the proteins. Normal levels were determined in 25 consecutive well children who were seeing their pediatrician for checkups (14 boys, 11 girls, ranging in age from 10 months to 17 years). Twenty-five consecutive burn victims admitted to the Shriners Burns Institute, Cincinnati Unit (19 boys, six girls, aged 10 months to 17 years), with a mean full-thickness burn of 43.2% TBSA (range, 6%-87%) were studied in the first week postburn. Antithrombin, alpha 2-antiplasmin, plasminogen, and prekallikrein levels decreased (p < 0.001) postburn, whereas elastase increased (p < 0.001). We conclude that, in pediatric burn patients, decreased proteinase inhibitors, increased proteinase, and activation of circulating proteinase cascades all contribute to elevated total circulating PA postburn.