Hemostatic markers and the sepsis‐related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit

Okabayashi, Kazuhiro; Wada, Hideo; Ohta, Setsuko; Shiku, Hiroshi; Nobori, Tsutomu; Maruyama, Kazuo

doi:10.1002/ajh.20089

Cited by 81 publications

(54 citation statements)

References 31 publications

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“…In our study, a significant difference was found in DIC score between overt and non-overt DIC; in addition, a significant correlation was found between DIC score and SOFA score only in overt DIC, suggesting that the severity of DIC may be an important determinant of outcome. 47 In accordance with our results, Toh and Downey 22 demonstrated that a score of 5 or more could diagnostically define patients with a poor prognosis from hemostatic dysfunction, independent of developing overt DIC. 20 Different study designs by Toh and Downey in different patient populations found that a worsening coagulopathy augers a worse outcome in patients with severe sepsis and increased development of new organ failure.…”

Section: Discussionsupporting

confidence: 92%

Tissue Factor Pathway Inhibitor and P-Selectin as Markers of Sepsis-Induced Non-overt Disseminated Intravascular Coagulopathy

Mosad

Elsayh

Eltayeb

2009

Clin Appl Thromb Hemost

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Inflammation and coagulation occur concomitantly in sepsis. Thrombin activates platelet that leads to P-selectin translocation, which upregulate tissue factor (TF) generation. Tissue factor pathway inhibitor (TFPI) is an anticoagulant that modulates coagulation induced by TF. The term non-overt disseminated intravascular coagulation (DIC) refers to a state of affairs prevalent before the occurrence of overt DIC. It was suggested that an initiation of treatment in non-overt DIC has better outcome than overt DIC. This study investigated the role of TFPI level, P-selectin, and thrombin activation markers in non-overt and overt DIC induced by sepsis and its relationship to outcome and organ dysfunction as measured by the Sequential Organ Failure Assessment (SOFA) score. It included 176 patients with sepsis. They were admitted to the pediatric intensive care unit (ICU).They included 144 cases of non-overt DIC and 32 cases of overt DIC. There was a significant difference in hemostatic markers, platelet count, partial thromboplastin time (PTT), P-selectin, thrombin activation markers, TFPI, and DIC score between overt and non-overt DIC in both groups. It was noticed that P-selectin was positively correlated with DIC score, fibrinogen consumption, fibrinolysis (D-dimer), thrombin activation markers, and TFPI. Tissue factor pathway inhibitor was significantly correlated with fibrinolysis, DIC score, and prothrombin fragment 1+2. Sequential Organ Failure Assessment score was correlated with DIC score and other hemostatic markers in patients with overt DIC. To improve the outcome of patients with DIC, there is a need to establish more diagnostic criteria for non-overt-DIC. Plasma levels of TFPI and P-selectin may be helpful in this respect.

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Section: Discussionsupporting

confidence: 92%

Tissue Factor Pathway Inhibitor and P-Selectin as Markers of Sepsis-Induced Non-overt Disseminated Intravascular Coagulopathy

Mosad

Elsayh

Eltayeb

2009

Clin Appl Thromb Hemost

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“…Since DIC is still a fatal condition [20], it is important to diagnose it early through the use of hemostatic molecular markers [21]. The International Society of Thrombosis and Haemostasis (ISTH) established diagnostic criteria for overt-DIC using fibrinrelated markers such as D-dimer [22].…”

Section: Introductionmentioning

confidence: 99%

Negative predictive value of d-dimer for diagnosis of venous thromboembolism

et al. 2008

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The D-dimer levels are considered to be useful for the diagnosis of thrombosis, and they can be clinically used as a negative predictive value (NPV). However, evidence for the efficacy of diagnosing thrombosis based on the D-dimer levels is still not well established. The present study was designed to evaluate the cut-off values of D-dimer levels as a negative predictor for thrombosis. The plasma concentrations of D-dimer were measured in inpatients suspected of having thrombosis, and then the findings were evaluated to assess the correlation with the diagnosis of thrombosis. In healthy volunteers, the median value of VIDAS-D-dimer was 0.12 microg/ml, and the 95% confidence interval was from 0.05 to 0.38 microg/ml. However, the plasma D-dimer levels were significantly higher in patients with thrombosis than in those without thrombosis; there was no significant difference in D-dimer levels among various thromboses such as pulmonary embolism (PE), deep vein thrombosis (DVT), and disseminated intravascular coagulation (DIC). The NPV for venous thromboembolism was 100% in patients with 0.5 microg/ml VIDAS-D-dimer and 1.2 microg/ml LPIA-D-dimer levels. Elevated D-dimer levels might indicate a high risk of thrombosis, especially DVT/PE, and they are thus considered to be useful as a negative predictor for thrombosis.

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“…During DIC, circulating thrombin–antithrombin (TAT)complexes are considered a measure of coagulation, and tissue plasminogen activator (tPA), its inhibitor plasminogen activator inhibitor (PAI) and plasmin–α 1 -antiplasmin (PAP) complexes are considered measures of fibrinolysis 8–21. Indeed, inhibition of fibrinolysis activation by PAI is an important predictor of multiple organ dysfunction and has a relatively high predictive value for a poor outcome in sepsis and DIC 8 9 13 14 16 19–21 27 28. However, it is unclear whether PAI is an independent predictor of mortality or a surrogate for multiple organ dysfunction in patients with septic DIC 21.…”

Section: Introductionmentioning

confidence: 99%

Relation between coagulation/fibrinolysis and lactate in the course of human septic shock

2010

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Hemostatic markers and the sepsis‐related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit

Cited by 81 publications

References 31 publications

Tissue Factor Pathway Inhibitor and P-Selectin as Markers of Sepsis-Induced Non-overt Disseminated Intravascular Coagulopathy

Tissue Factor Pathway Inhibitor and P-Selectin as Markers of Sepsis-Induced Non-overt Disseminated Intravascular Coagulopathy

Negative predictive value of d-dimer for diagnosis of venous thromboembolism

Relation between coagulation/fibrinolysis and lactate in the course of human septic shock

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