[An analysis of DIC in patients with multiple organ failure--variations of the molecular makers and its clinical usefulness].
We studied blood coagulation and fibrinolysis in 18 DIC patients with multiple organ failure. Blood was collected three times (1st, 3rd, 6th hospital days) from an indwelling arterial line, and FPA, FPB beta 15-42, alpha 2PI-P1-C, D-dimer, t-PA; Ag, and t-PA activity were measured. 1) Continuous FOY infusion (1.40 +/- 0.07 mg/kg/H) resulted in a statistically significant fall of FPA levels, which however, was still above normal. The FPA levels of the patients whose DIC score was not improved or who had massive hematomas were statistically higher than the patients whose DIC score was improved or without hematomas. 2) FPB beta 15-42, alpha 2PI-Pl-C, and D-dimer remained at consistently high levels following onset of the DIC. A significant positive correlations were seen between these indices; between the FPA and FPB beta 15-42, alpha 2PI-Pl-C. 3) The levels of alpha 2PI-Pl-C were found to be higher in the patients with hematomas than those without hematomas. 4) T-PA; Ag level remained at consistently high during all hospital day. On the other hand, t-PA activity level did not change significantly. There was dissociation between the t-PA; Ag and the t-PA activity. 5) The patients whose DIC score were not improved on the 6th hospital day had higher levels of t-PA; Ag than the patients whose DIC score were improved, but there were no differences in the number of the ischemic organs between these patients. In conclusion, regardless of the continuous FOY infusion some patients revealed the continuous production of thrombin.(ABSTRACT TRUNCATED AT 250 WORDS)
Gando
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S
Department of Emergency and Critical Care Medicine, Sapporo City General Hospital.
Tedo
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D000328:Adult; D000933:Antifibrinolytic Agents / Q000032:analysis; D015415:Biomarkers; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis*; D005260:Female; D005341:Fibrinolysin / Q000032:analysis; D005344:Fibrinopeptide A / Q000032:analysis*; D005345:Fibrinopeptide B / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications*; D011379:Prognosis; D010959:Tissue Plasminogen Activator / Q000032:analysis; D000979:alpha-2-Antiplasmin
D000933:Antifibrinolytic Agents; D015415:Biomarkers; D000979:alpha-2-Antiplasmin; C037742:plasmin-plasmin inhibitor complex; D005344:Fibrinopeptide A; D005345:Fibrinopeptide B; D010959:Tissue Plasminogen Activator; D005341:Fibrinolysin