• J Trauma · Nov 2007

    Multicenter Study Comparative Study Clinical Trial

    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, and Japanese Association for Acute Medicine Disseminated Intravascular Coagulation Study Group.
    • Division Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine. iba-jun@umin.ac.jp
    • J Trauma. 2007 Nov 1;63(5):1093-8.

    IntroductionThe 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.MethodsSixty-six SIRS patients with a platelet count less than 15.0 x 10(4)/mm3 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).ResultsSignificant 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-[alpha]2-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.ConclusionThe 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.

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