Toenges Rosa, Steiner Michael, Weber Christian Friedrich, Miesbach Wolfgang
Department of Medicine, Hemostaseology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany.
Medizinisches Labor Rostock, Rostock, Germany.
Front Med (Lausanne). 2023 Dec 13;10:1294301. doi: 10.3389/fmed.2023.1294301. eCollection 2023.
Inherited or acquired molecular abnormalities form a clinically heterogeneous group of fibrinogen disorders called dysfibrinogenaemia. Apart from a pediatric case report and in contrast to other clinical conditions, acquired dysfibrinogenaemia has not been previously reported in septic patients.
In an observational cohort study, 79 adult septic patients were investigated for the presence of acquired dysfibrinogenaemia at the time of their admission to the intensive care unit (ICU) of the University Hospital Frankfurt. Following established recommendations, fibrinogen clotting activity vs. antigen ratios were analyzed using Clauss fibrinogen, prothrombin-derived fibrinogen, and radial immunodiffusion (RID) fibrinogen concentration.
Prothrombin-derived fibrinogen levels were highest (527 ± 182 mg/dL) followed by Clauss fibrinogen (492 ± 209 mg/dL) and radial immunodiffusion fibrinogen (426 ± 159 mg/dL). Very few cases demonstrated hypofibrinogenaemia making overt disseminated intravascular coagulation (DIC) unlikely in the cohort investigated. Clauss/RID fibrinogen ratios were lower (1.17 ± 0.19) compared to prothrombin time-derived/RID ratios (1.35 ± 0.33). Using the Clauss/RID dataset, 21% of patients (16/76 patients) demonstrated values below a threshold ratio for suspected acquired dysfibrinogenaemia arbitrarily set at 1.0. In contrast, prothrombin-derived ratios were below the threshold in only 7% (4/58 patients).
The results point to the presence of acquired dysfibrinogenaemia in part of adult septic patients. If confirmed in further studies, this may form part of a specific laboratory signature of a sepsis-associated coagulation phenotype.
遗传性或获得性分子异常形成了一组临床异质性的纤维蛋白原疾病,称为异常纤维蛋白原血症。除了一篇儿科病例报告外,与其他临床情况不同,此前尚未有关于脓毒症患者获得性异常纤维蛋白原血症的报道。
在一项观察性队列研究中,对79名成年脓毒症患者在入住法兰克福大学医院重症监护病房(ICU)时进行了获得性异常纤维蛋白原血症的调查。按照既定建议,使用克劳斯纤维蛋白原法、凝血酶原衍生纤维蛋白原法和放射免疫扩散(RID)纤维蛋白原浓度分析法分析纤维蛋白原凝血活性与抗原比值。
凝血酶原衍生纤维蛋白原水平最高(527±182mg/dL),其次是克劳斯纤维蛋白原(492±209mg/dL)和放射免疫扩散纤维蛋白原(426±159mg/dL)。很少有病例表现为纤维蛋白原减少血症,在所研究的队列中不太可能出现明显的弥散性血管内凝血(DIC)。与凝血酶原时间衍生/RID比值(1.35±0.33)相比,克劳斯/RID纤维蛋白原比值较低(1.17±0.19)。使用克劳斯/RID数据集,21%的患者(16/76例患者)的比值低于疑似获得性异常纤维蛋白原血症的阈值比值,该阈值比值被任意设定为1.0。相比之下,凝血酶原衍生比值仅7%(4/58例患者)低于阈值。
结果表明部分成年脓毒症患者存在获得性异常纤维蛋白原血症。如果在进一步研究中得到证实,这可能构成脓毒症相关凝血表型的特定实验室特征的一部分。