Usefulness of circulating vascular endothelial growth factor and neutrophil elastase as diagnostic markers of disseminated intravascular coagulation in non-cancer patients.
BACKGROUND
Disseminated intravascular coagulation (DIC) is characterized by platelet and neutrophil activation. Platelets are the major source of circulating vascular endothelial growth factor (VEGF). Endostatin, an anti-angiogenic factor, is a fragment of collagen that is released from the extracellular matrix via the active cleavage of neutrophil elastase, thereby increasing the circulating level of endostatin. Hypercoagulable conditions such as DIC may induce the release of VEGF and neutrophil elastase from the platelets and neutrophils.


METHODS
We enrolled 240 patients who were clinically suspected of having DIC. Plasma levels of VEGF, endostatin, and neutrophil elastase were determined using commercial ELISA kits. Patients were diagnosed as having overt DIC if the cumulative International Society on Thrombosis and Haemostasis Subcommittee score was >5.


RESULTS
Overt DIC was diagnosed in 80 of the 240 patients. The circulating VEGF and neutrophil elastase levels gradually increased according to the severity of coagulopathy, as reflected by the DIC score. However, the circulating endostatin level did not change significantly according to the DIC score. We divided the patients into 2 groups: the non-cancer and cancer patient groups, to exclude the VEGF release from tumor tissues. Interestingly, in non-cancer patients, higher VEGF and neutrophil elastase levels were found to be significant diagnostic markers for overt DIC.


CONCLUSIONS
Our findings suggest that circulating VEGF and neutrophil elastase levels are laboratory markers reflecting coagulation activity. They are expected to be potential diagnostic markers of overt DIC, especially in non-cancer patients.
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
Shin Young
SY
Joo
Ji-Eun
JE
Kim
Ju Young
JY
Kim
Kyou-Sup
KS
Han
Hyun Kyung
HK
Kim