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Ratio of Angiopoietin-2 to Angiopoietin-1 predicts mortality in acute lung injury induced by paraquat

Jae-Sung Choi, Kyung-A Kwak, Min-Ju Park, Young-Hee Kim, Hyo-Wook Gil, Ho-yeon Song, Sae-yong Hong

Med Sci Monit 2013; 19:28-33

DOI: 10.12659/MSM.883730

Available online:

Published: 2013-01-09

Background:   To determine whether initial reactive oxygen species (ROS)-induced endothelial cell injury is involved in early death after paraquat intoxication and concentrations of angiopoietin-1 (Ang-1), angiopoietin-2 (Ang-2), and von Willebrand factor (VWF) reflecting endothelial cell injury, we investigated the initial endothelial cell injury marker involved in the pathogenesis of death within 5 days after paraquat ingestion.
            Material/Methods:      Sixty patients with paraquat poisoning were prospectively enrolled. Plasma samples were collected at admission. Plasma concentrations of Ang-1, Ang-2, and VWF were measured by enzyme-linked immunosorbent assay. The patients were classified into 3 categories: survivors, early death (died within 5 days after ingestion), and late death (died more than 5 days after ingestion).
            Results:           The baseline concentration of Ang-2 and the Ang-2: Ang-1 ratio were significantly higher in patients who died (Ang-2 [pg/mL], 1012.75±468.02 vs. 1986.07±1675.37 [p=0.002]; Ang-2: Ang-1, 0.90±0.49 vs. 2.16±2.28 [p=0.002]). The Ang-2: Ang-1 ratio was significantly higher in the early death group (2.41±2.54) than in the survivors (0.90±0.49) and the late death group (1.33±0.64). The Ang-2: Ang-1 ratio was significantly associated with early death (OR, 2.602; 95% CI, 1.106–6.117; p=0.028) after adjusting for plasma levels of paraquat, age, PCO2, and creatinine. VWF did not predict mortality.
            Conclusions:   Endothelial cell damage could be involved in the pathogenesis of early death following paraquat ingestion.

Keywords: Paraquat - poisoning, Angiopoietin-2 - blood, Angiopoietin-1 - blood, Acute Lung Injury - mortality, Survival Analysis