title: Increased mortality in systemic inflammatory response syndrome patients with high levels of coagulation factor VIIa.
abstract: BACKGROUND
  The tissue factor (TF)- Factor VIIa (FVIIa) complex has a pivotal role in inflammatory and coagulation responses in patients with systemic inflammatory response syndrome (SIRS) and sepsis. Because zymogen FVII (FVII) and FVIIa compete for binding to TF, their plasma levels determine if a catalytically active TF-FVIIa complex will be formed.
  
  
  OBJECTIVE
  To study mortality in SIRS patients as a function of FVIIa and FVII levels in plasma.
  
  
  METHODS
  This was a cohort study of 275 patients presenting with SIRS, aged 18 years or older and with an anticipated Intensive Care Unit (ICU) stay of at least 24 h. FVIIa was measured using a novel, quantitative assay that recognizes FVIIa, but not FVII. All-cause hospital mortality was followed over a period of 60 days.
  
  
  RESULTS
  The percentage of FVII measured as FVIIa was higher in non-survivors than survivors (2.8%, IQR = 1-5.5% vs. 1.5%, IQR = 0.6-3.3%; P = 0.034). High levels of FVIIa were associated with decreased 60-day cumulative survival (62% vs. 81%, P = 0.030); the opposite was observed for FVII (84% vs. 76%, P = 0.039). Patients with high-FVIIa and low-FVII levels had a three-fold increased hazard ratio (HR) compared with the patients that had low-FVIIa and high-FVII levels (HR = 3.24, 95% confidence interval [CI] = 1.41-7.36). This association persisted after adjusting for the APACHE IV score (adjusted HR = 2.75, 95% CI = 1.2-6.27).
  
  
  CONCLUSIONS
  SIRS patients with high-FVIIa and low-FVII on admission have an increased mortality risk, an association that is independent from the parameters included in the APACHE IV score.
authors.affiliation: Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Hyseni
authors.forename: H
authors.initials: H
authors.lastname: Kemperman
authors.forename: D W
authors.initials: DW
authors.lastname: de Lange
authors.forename: P G
authors.initials: PG
authors.lastname: de Groot
authors.forename: M
authors.initials: M
authors.lastname: Linssen
authors.forename: J
authors.initials: J
authors.lastname: Kesecioglu
authors.forename: T
authors.initials: T
authors.lastname: Lisman
authors.forename: M
authors.initials: M
authors.lastname: Roest
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D015942:Factor VIIa / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000401:mortality*
chemical_list: D015942:Factor VIIa
keywords: critical care; factor VII; factor VIIa; sepsis; systemic inflammatory response syndrome; tissue factor