Coagulopathy in Disseminated Intravascular Coagulation due to Abdominal Sepsis: Determination of Prothrombin Fragment 1+2 and Other Markers

Abstract

To estimate the degree of coagulopathy in abdominal sepsis, we measured the plasma levels of prothrombin fragment 1+2 (F1+2), thrombin-antithrombin III complex (TAT) and plasmin-Α₂-plasmin inhibitor complex (PIC) by the enzyme-linked immunosorbent assay in 38 patients with disseminated intravascular coagulation (DIC). In 20 patients with DIC due to abdominal sepsis, plasma levels of F1+2, TAT and PIC were 2.6 nmol/l, 27.9 µg/l and 1.5 µg/ml, respectively, with a mean antithrombin III (AT III) activity of 41.7%. F1+2, TAT, PIC and AT III levels were 4.7 nmol/l, 75.8 µg/l, 8.8 µg/ml and 70.9% in 18 patients with DIC as the result of malignancy. Though AT III levels in DIC due to sepsis were lower than those in DIC due to malignancy, the levels of F1+2, TAT and PIC in the former were not significantly more increased than those in the latter. The plasma levels of F1+2 were positively correlated with TAT and PIC in DIC patients with malignancy; however, there was no correlation between F1+2 and TAT or PIC in DIC patients with sepsis. In addition, the levels of serum albumin in the two groups were similar. These results suggest that activation of coagulation and fibrinolytic systems may not be so prominent in cases of DIC due to abdominal sepsis, compared to related events in DIC due to malignancy. It is also suggested that the depletion of AT III in cases of sepsis is not only caused by a consumption related to intravascular coagulation or to an alternate distribution of protein. It may relate to nonspecific proteolytic degradation by granulocytic proteinases. F1+2 may be more suitable than TAT for the evaluation of the coagulopathy in DIC patients with sepsis.

Prothrombotic Coagulation Abnormalities Preceding the Hemolytic–Uremic Syndrome

“…The concentrations of prothrombin fragment 1+2 during the first four days of illness were as high as those in patients with disseminated intravascular coagulation caused by abdominal sepsis or cancer 21 and were similar to the concentrations of fragment 1+2 observed in children with the hemolytic-uremic syndrome in European studies. 10,11 These elevations demonstrate that in E. coli O157:H7 infection, prothrombin is being converted to thrombin at an early stage of illness, when the hematocrit, platelet count, and serum creatinine concentration are normal.…”

Study of the prognostic factor of the colon perforation case with the pan‐peritonitis that needed emergency surgery: a single‐center observational study

“…To our knowledge, however, there are no reports of the acute DIC score as a prognostic factor for colon perforation. The acute DIC score is a score used in the emergency intensive care field for diagnosing DIC, and the mortality rate of patients diagnosed as having DIC according to the acute‐phase DIC diagnostic criteria, and not only in those with colon perforation, was approximately 20–21% and was 34.7% when the DIC was caused by sepsis . The high value of the acute DIC score in the case of colon perforation leads to the diagnosis of DIC caused by intraperitoneal infection, so it was easy to understand that the acute DIC score would be high in the death group and would be useful as a prognostic factor.…”

Disseminated Intravascular Coagulation: Pathophysiological Mechanisms and Manifestations

“…137 Approved ELISA assays are now generally available to quantitate the levels of prothrombin fragment F 1+2 and TAT within the circulation to provide evidence of excessive Factor Xa and thrombin generation. 138 The prothrombin fragment 1+2 assay is an easily performed reliable molecular marker for Factor Xa generation, [139][140][141][142][143][144][145] while the fibrinopeptide A assay, subsequently discussed, is an easily performed reliable marker for thrombin generation. Unfortunately, some commercially available prothrombin fragment assays do not provide reliable results in DIC patients; so, our laboratories prefer the Behring Diagnostics, Inc. assay.…”