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

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.