Impaired fibrinolysis in the pathogenesis of dengue hemorrhagic fever.
The mechanisms contributing to bleeding complications in dengue hemorrhagic fever were studied by investigating the pattern of activation of the coagulation and fibrinolytic systems in 50 children with severe dengue hemorrhagic fever. Thirteen patients (26%) died, and activation of coagulation was most pronounced in the deceased group. Fibrinolysis was also activated, but this activation was relatively weak compared with that of coagulation as a result of persistently high plasminogen activator inhibitor levels. Plasminogen activator inhibitor also prevented a switch from the procoagulant to the profibrinolytic state in lethal dengue hemorrhagic fever, which was further enhanced by an acquired protein C deficiency. The present study is the first to demonstrate such a mechanism in a viral infection. This imbalance between coagulation and fibrinolysis may be used as a prognostic marker, but it may also be a target for future therapeutic intervention.
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, Netherlands. ecmvangorp@yahoo.co.uk
Eric C M
EC
Van Gorp
Tatty E
TE
Setiati
Albert T A
AT
Mairuhu
Catharina
C
Suharti
Hugo ten
Ht
Cate Ht
Wil M V
WM
Dolmans
Jos W M
JW
Van Der Meer
C Erik
CE
Hack
Dees P M
DP
Brandjes
D015415:Biomarkers / Q000097:blood; D001780:Blood Coagulation Tests; D002648:Child; D002675:Child, Preschool; D005342:Fibrinolysis; D006801:Humans; D008137:Longitudinal Studies; D011379:Prognosis; D019595:Severe Dengue / Q000097:blood* / Q000145:classification / Q000503:physiopathology*
D015415:Biomarkers