• MüllerMarcella C AMCADepartment of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Romein W G Dujardin, Jecko Thachil, Gerard van Mierlo, Sacha S Zeerleder, and Nicole P Juffermans.
• Department of Intensive Care Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
• J. Intern. Med. 2021 Oct 1; 290 (4): 922-927.

BackgroundNucleosomes and neutrophil extracellular traps (NETs) are important in the pathophysiology of disseminated intravascular coagulation (DIC). Fibrinogen, as an acute phase reactant, may be protective by engaging neutrophils. We hypothesize that DIC can occur when NET formation becomes uncontrolled in relation to low fibrinogen levels.Patients/MethodThe ratio of both circulating nucleosomes and human neutrophil elastase alpha-1-antitrypsine complexes (HNE-a1ATc) to fibrinogen was correlated to thrombocytopenia, DIC and organ failure in 64 critically ill coagulopathic patients.ResultsA high nucleosome to fibrinogen ratio correlated with thrombocytopenia and organ failure (ρ -0.391, p 0.01 and ρ 0.556, p 0.01, respectively). A high HNE-a1ATc to fibrinogen ratio correlated with thrombocytopenia, DIC and organ failure (ρ -0.418, p 0.01, ρ 0.391, p 0.01 and ρ 0.477, p 0.01 respectively).ConclusionThese findings support the hypothesis that fibrinogen is protective against DIC by counterbalancing excessive neutrophil activation.© 2021 The Association for the Publication of the Journal of Internal Medicine.

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