Department of Pediatrics, Nara Medical University, Kashihara, Nara, Japan.
Pediatr Int. 2021 Nov;63(11):1311-1318. doi: 10.1111/ped.14684. Epub 2021 Oct 26.
Sepsis is a common underlying disease associated with disseminated intravascular coagulation (DIC). We have recently determined hemostatic pathological states at diagnosis through simultaneous assessment of coagulation and fibrinolysis potentials in sepsis-associated DIC using clot-fibrinolysis waveform analysis. Here we aimed to investigate hemostatic pathological states, focusing on the balance between coagulation and fibrinolysis dynamics during the clinical course in pediatric sepsis-associated DIC.
Coagulation and fibrinolysis potential functions in three pediatric patients with sepsis-associated DIC during their clinical course were quantified using clot-fibrinolysis waveform analysis. A maximum coagulation velocity (|min1|) and maximum fibrinolysis velocity (|FL-min1|) was calculated as a ratio relative to normal plasma.
In case 1, coagulation-enhanced and fibrinolysis-depressed state (|min1|-ratio 2.22 and |FL-min1|-ratio 0.42) was observed on day 1. This discrepancy significantly reduced after anticoagulant therapy and plasma exchange on day 2. A well-balanced hemostatic state (0.70 and 0.62, respectively) was restored on day 7. In case 2, fibrinolysis-impaired state (|min1|-ratio 1.09 and |FL-min1|-ratio 0.21) was seen on day 1. The |min1| ratio was slightly prolonged and the |FL-min1| ratio was severely decreased. Both were restored on day 7 and returned to normal levels on day 12. In case 3, twofold coagulation- and fibrinolysis-enhanced states (|min1|-ratio 1.99 and |FL-min1|-ratio 1.11) were seen on day 1. However, both potentials rapidly decreased on day 2 (0.49 and 0.0, respectively). She died on day 5.
The hemostatic pathological states in sepsis-associated DIC depend on disease progression. Comprehensive assessment of coagulation-fibrinolysis potentials over time may therefore be helpful in considering optimal treatment plans for sepsis-associated DIC.
脓毒症是一种常见的基础疾病，与弥漫性血管内凝血（DIC）有关。我们最近通过使用血栓-纤维蛋白溶解波型分析同时评估脓毒症相关 DIC 中的凝血和纤维蛋白溶解潜能，确定了 DIC 的止血病理状态。在此，我们旨在研究止血病理状态，重点关注儿科脓毒症相关 DIC 患者临床病程中凝血和纤维蛋白溶解动力学之间的平衡。
使用血栓-纤维蛋白溶解波型分析量化了 3 例脓毒症相关 DIC 患儿在其临床病程中的凝血和纤维蛋白溶解潜能功能。计算最大凝血速度（|min1|）和最大纤维蛋白溶解速度（|FL-min1|），并相对于正常血浆进行了比值计算。
在病例 1 中，在第 1 天观察到凝血增强和纤维蛋白溶解受抑状态（|min1|-比值为 2.22，|FL-min1|-比值为 0.42）。在第 2 天接受抗凝治疗和血浆置换后，这种差异显著减少。在第 7 天，恢复了平衡的止血状态（分别为 0.70 和 0.62）。在病例 2 中，在第 1 天观察到纤维蛋白溶解受损状态（|min1|-比值为 1.09，|FL-min1|-比值为 0.21）。|min1|比值略有延长，|FL-min1|比值严重降低。两者均在第 7 天恢复，在第 12 天恢复正常水平。在病例 3 中，在第 1 天观察到两倍的凝血和纤维蛋白溶解增强状态（|min1|-比值为 1.99，|FL-min1|-比值为 1.11）。然而，这两种潜能在第 2 天迅速下降（分别为 0.49 和 0.0）。她于第 5 天死亡。
脓毒症相关 DIC 的止血病理状态取决于疾病进展。因此，随着时间的推移对凝血-纤维蛋白溶解潜能进行全面评估可能有助于考虑脓毒症相关 DIC 的最佳治疗方案。
