SIRS-associated coagulopathy and organ dysfunction in critically ill patients with thrombocytopenia.
BACKGROUND
Coagulopathy and thrombocytopenia often occur in critically ill patients, and disseminated intravascular coagulation (DIC) can lead to multiple organ dysfunction and a poor outcome. However, the relation between coagulopathy and systemic inflammatory response has not been thoroughly clarified. Thus, we evaluated coagulative activity, organ dysfunction, and systemic inflammatory response syndrome (SIRS) in critically ill patients with thrombocytopenia and examined the balance between coagulopathy and systemic inflammation.


METHODS
Two hundred seventy-three patients, who were admitted to 13 critical care centers in Japan and fulfilled the criteria of platelet count of less than 150*10(9)/L, were included. Coagulative variables (platelet count, fibrin/fibrinogen degradation products, and DIC scores), organ dysfunction index (Sequential Organ Failure Assessment [SOFA] score), and SIRS score in each patient were evaluated for 4 consecutive days after fulfilling the above entry criteria. The effect of SIRS on coagulopathy and organ dysfunction was evaluated in these patients.


RESULTS
Both the maximum SIRS score and entry SIRS score had significant relation to the maximum SOFA score during the observation period. Coagulation disorders indicated by the minimum platelet count, maximum DIC scores, and positivity for DIC worsened gradually with increases in SIRS scores. Both the minimum platelet count and maximum DIC scores were significantly correlated with the maximum SOFA score, indicating that a relation exists between coagulopathy and organ dysfunction.


CONCLUSIONS
In critically ill patients with thrombocytopenia, coagulopathy and organ dysfunction progress with significant mutual correlation, depending on the increase in SIRS scores. The SIRS-associated coagulopathy may play a critical role in inducing organ dysfunction after severe insult.
Ogura
Hiroshi
H
Department of Traumatology and Acute Critical Medicine, Osaka University Medical School, Suita, Japan. ogura@hp-emerg.med.osaka-u.ac.jp
Gando
Satoshi
S
Iba
Toshiaki
T
Eguchi
Yutaka
Y
Ohtomo
Yasuhiro
Y
Okamoto
Kohji
K
Koseki
Kazuhide
K
Mayumi
Toshihiko
T
Murata
Atsuo
A
Ikeda
Toshiaki
T
Ishikura
Hiroyasu
H
Ueyama
Masashi
M
Kushimoto
Shigeki
S
Saitoh
Daizoh
D
Endo
Shigeatsu
S
Shimazaki
Shuji
S
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000209:etiology; D016638:Critical Illness; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000209:etiology; D010976:Platelet Count; D018805:Sepsis / Q000097:blood; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000209:etiology; D013921:Thrombocytopenia / Q000097:blood* / Q000150:complications
D005338:Fibrin Fibrinogen Degradation Products; D005337:Fibrin