High plasma fibrinogen level is associated with poor clinical outcome in DIC patients.
We measured the plasma level of fibrinogen in 560 patients with disseminated intravascular coagulation (DIC) and evaluated its relationship with outcome and with other hemostatic markers. Forty-seven percent of patients had >200 mg/dL of plasma fibrinogen and 24% had <100 mg/dl of plasma fibrinogen, suggesting that plasma fibrinogen level is not a sensitive marker for DIC. In our analysis of outcome and plasma fibrinogen levels, the rate of death was high in leukemia/lymphoma patients with high fibrinogen concentration, but no significant difference in outcome was observed in relation to plasma fibrinogen concentration in non-leukemia/lymphoma patients with DIC. Among patients with leukemia/lymphoma, the frequency of organ failure was markedly high in patients with high plasma levels of fibrinogen. Among patients without leukemia/lymphoma, the frequency of organ failure increased concomitantly with the increase in plasma fibrinogen levels. The international normalized ratio was significantly increased in leukemia/lymphoma patients with low fibrinogen. FDP levels were slightly increased in patients with low fibrinogen. Platelet count was significantly low in patients without leukemia/lymphoma with high fibrinogen. DIC score increased concomitantly with the reduction in plasma fibrinogen levels. Plasma levels of thrombomodulin and tissue factor were significantly high in patients with high fibrinogen levels. Plasma levels of antiplasmin and plasminogen were significantly decreased in patients with low fibrinogen. Plasma levels of plasmin plasmin-inhibitor complex and tissue type plasminogen activator/plasminogen activator inhibitor-1 complex (PAI-I) were significantly higher in patients with low fibrinogen than in those with high fibrinogen. Plasma levels of PAI-I and IL-6 were significantly higher in patients with high fibrinogen than in those with low fibrinogen. Patients with high fibrinogen levels showed less activation of secondary fibrinolysis, which might explain the occurrence of organ failure and poor outcome.
Wada
Hideo
H
Department of Clinical Laboratory, Mie University School of Medicine, Tsu-City, Japan. wadahide@clin.miedic.mie-u.ac.jp
Mori
Yoshitaka
Y
Okabayashi
Kazuhiro
K
Gabazza
Esteban C
EC
Kushiya
Fumihiko
F
Watanabe
Masato
M
Nishikawa
Masakatsu
M
Shiku
Hiroshi
H
Nobori
Tsutomu
T
D000328:Adult; D000368:Aged; D000933:Antifibrinolytic Agents / Q000032:analysis; D000990:Antithrombin III / Q000032:analysis; D015415:Biomarkers; D004211:Disseminated Intravascular Coagulation / Q000097:blood*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis*; D005341:Fibrinolysin / Q000032:analysis; D005342:Fibrinolysis; D019337:Hematologic Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007239:Infections / Q000097:blood / Q000150:complications / Q000401:mortality*; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications / Q000401:mortality; D009369:Neoplasms / Q000097:blood / Q000150:complications / Q000401:mortality*; D010447:Peptide Hydrolases / Q000032:analysis; D010958:Plasminogen / Q000032:analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D010976:Platelet Count; D011379:Prognosis; D018180:Thrombomodulin / Q000097:blood; D013925:Thromboplastin / Q000032:analysis; D013927:Thrombosis / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000097:blood; D000979:alpha-2-Antiplasmin / Q000032:analysis
D000933:Antifibrinolytic Agents; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D007375:Interleukin-1; D015850:Interleukin-6; D017395:Plasminogen Activator Inhibitor 1; D018180:Thrombomodulin; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C037742:plasmin-plasmin inhibitor complex; D000990:Antithrombin III; D005340:Fibrinogen; D010958:Plasminogen; D013925:Thromboplastin; D010447:Peptide Hydrolases; D010959:Tissue Plasminogen Activator; D005341:Fibrinolysin