title: Poor prognosis of hypocoagulability assessed by thrombin generation assay in disseminated intravascular coagulation.
abstract: Overall assessment of the hemostatic system including procoagulant and anticoagulant changes may help assess the clinical status and prognosis of disseminated intravascular coagulation (DIC). The thrombin generation assay provides useful information about the global hemostatic status. Therefore, we measured several parameters of global hemostatic potential by the thrombin generation assay in patients suspected of having DIC. A total of 114 patients with suspected DIC were included. The thrombin generation assay was performed on the calibrated automated thrombogram using tissue factor with or without the addition of thrombomodulin, showing three parameters: lag time, endogenous thrombin potential (ETP), and peak thrombin. Both 1 and 5 pmol/l tissue factor-stimulated ETP and peak thrombin were well correlated with DIC severity. Interestingly, antithrombin level greatly affected ETP, whereas protein C influenced lag time. Prognostic analysis revealed that the area under the curve of peak thrombin stimulated by 1 pmol/l tissue factor was superior to that of D-dimer. Moreover, multivariate Cox analysis showed that the lag time and time to peak with both 1 and 5 pmol/l tissue factor were independent prognostic markers. ETP and peak thrombin well reflect DIC severity. Hypocoagulability manifesting as prolonged lag time and time to peak is expected to be an independent prognostic marker in DIC.
authors.affiliation: aDepartment of Laboratory Medicine bCancer Research Institute cDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea *Kyunghoon Lee and Ji-Eun Kim contributed equally to this work.
authors.forename: Kyunghoon
authors.initials: K
authors.lastname: Lee
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Jihyun
authors.initials: J
authors.lastname: Kwon
authors.forename: Inho
authors.initials: I
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.forename: Seonyang
authors.initials: S
authors.lastname: Park
authors.forename: Kyou-Sup
authors.initials: KS
authors.lastname: Han
authors.forename: Hyun Kyung
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000368:Aged; D001780:Blood Coagulation Tests / Q000379:methods*; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013917:Thrombin / Q000032:analysis / Q000096:biosynthesis*
chemical_list: D013917:Thrombin