The role of cytokines in activation of coagulation and fibrinolysis in dengue shock syndrome.
In a prospective clinical study of 50 patients with Dengue Shock Syndrome (DSS), we investigated the association of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), IL-1 receptor antagonist (IL-1Ra), and IL-6 with activation markers of coagulation (F1+2 and TATc) and fibrinolysis (t-PA, PAPc, and D-dimer). We found that TNF-alpha, IL-1beta and Il-1Ra, but not IL-6, concentrations were elevated in the circulation during the early stage of infection and at discharge from hospital. TNF-alpha was significantly associated with D-dimer, an activation marker of fibrinolysis (p < 0.003), but not with activation markers of coagulation. IL-1beta was significantly associated with t-PA (p < 0.03). IL-1Ra was significantly associated with F1+2, TATc (p < 0.04 and p < 0.02, respectively), whereas IL-6 was significantly associated with both, activation markers of coagulation (F1+2; p < 0.03) and fibrinolysis (PAPc; p = 0.002). Our data are in line with studies in bacterial sepsis. In severe dengue virus infection the same cytokines are involved in the onset and regulation of hemostasis.
Suharti
Catharina
C
Department of Medicine, Faculty of Medicine, Diponegoro University and Dr. Kariadi Hospital, Semarang, Indonesia.
van Gorp
Eric C M
EC
Setiati
Tatty E
TE
Dolmans
Wil M V
WM
Djokomoeljanto
Robert J
RJ
Hack
C Erik
CE
ten
Cate Hugo
CH
van der Meer
Jos W M
JW
D000293:Adolescent; D000933:Antifibrinolytic Agents / Q000032:analysis; D000990:Antithrombin III / Q000032:analysis; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D016207:Cytokines / Q000097:blood / Q000502:physiology*; D004196:Disease Outbreaks; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005341:Fibrinolysin / Q000032:analysis; D005342:Fibrinolysis; D006474:Hemorrhagic Disorders / Q000097:blood* / Q000209:etiology; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D053590:Interleukin 1 Receptor Antagonist Protein; D007375:Interleukin-1 / Q000097:blood / Q000502:physiology; D015850:Interleukin-6 / Q000097:blood / Q000502:physiology; D008297:Male; D010446:Peptide Fragments / Q000032:analysis; D010447:Peptide Hydrolases / Q000032:analysis; D011446:Prospective Studies; D011516:Prothrombin / Q000032:analysis; D019595:Severe Dengue / Q000097:blood* / Q000453:epidemiology; D012795:Sialoglycoproteins / Q000097:blood / Q000502:physiology; D010959:Tissue Plasminogen Activator / Q000032:analysis; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000502:physiology; D000979:alpha-2-Antiplasmin / Q000032:analysis
D000933:Antifibrinolytic Agents; D015415:Biomarkers; D016207:Cytokines; D005338:Fibrin Fibrinogen Degradation Products; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D007375:Interleukin-1; D015850:Interleukin-6; D010446:Peptide Fragments; D012795:Sialoglycoproteins; D014409:Tumor Necrosis Factor-alpha; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C037742:plasmin-plasmin inhibitor complex; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator; D005341:Fibrinolysin