Predicting the severity of systemic inflammatory response syndrome (SIRS)-associated coagulopathy with hemostatic molecular markers and vascular endothelial injury markers

Toshiaki Iba, Satoshi Gando, Atsuo Murata, Shigeki Kushimoto, Daizoh Saitoh, Yutaka Eguchi, Yasuhiro Ohtomo, Kohji Okamoto, Kazuhide Koseki, Toshihiko Mayumi, Toshiaki Ikeda, Hiroyasu Ishhikura, Masashi Ueyama, Yuji Ogura, Shigeatsu Endo, Shuji Shimazaki

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)

Abstract

INTRODUCTION: The changes in biomarkers of coagulation or fibrinolysis, anticoagulation, inflammation, and endothelial damage occur in patients with systemic inflammatory response syndrome (SIRS). The purpose of this study is to assess the prognostic value of these markers in patients with SIRS-associated hypercoagulopathy. METHODS: Sixty-six SIRS patients with a platelet count less than 15.0 × 10/mm in three university hospital intensive care units were enrolled in this prospective, comparative study. Blood samples were obtained on day 0 and day 2. Twelve hemostatic, inflammatory, and vascular endothelial indices were measured and the data were compared between the severe group (patients with a total maximum Sequential Organ Failure Assessment score of 10 or more and nonsurvivors; n = 25) and the less-severe group (Sequential Organ Failure Assessment score <10; n = 41). RESULTS: Significant changes between the groups were observed in platelet count, fibrin or fibrinogen degradation products, interleukin-6, soluble thrombomodulin, antithrombin (AT) activity, and protein C activity, both on day 0 and on day 2. In contrast, the d-dimer, soluble fibrin, plasmin-α2-antiplasmin complex, and E-selectin levels were higher in the severe group only on day 2. No significant difference was seen regarding the thrombin-AT complex and total plasminogen activator inhibitor on both days. A comparison of the areas under the receiver operating characteristic curve revealed the AT activity to be the best predictor of a progression of organ dysfunction. CONCLUSION: The changes in some hemostatic molecular markers and vascular endothelial markers were conspicuous in patients with organ dysfunction. The AT activity is considered to be the most useful predictor of organ dysfunction.

Original languageEnglish
Pages (from-to)1093-1098
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume63
Issue number5
DOIs
Publication statusPublished - 2007 Nov
Externally publishedYes

Keywords

  • Antithrombin activity
  • Hemostatic molecular markers
  • Hypercoagulopathy
  • Organ dysfunction
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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