Gando S, Kameue T, Nanzaki S, Nakanishi Y
Department of Emergency and Critical Care Medicine, Japan.
Thromb Haemost. 1996 Feb;75(2):224-8.
To evaluate the role of disseminated intravascular coagulation (DIC) and to determine the influence of antithrombin, protein C, and plasminogen activator inhibitor 1 on multiple organ dysfunction syndrome (MODS) and outcome in patients with systemic inflammatory response syndrome (SIRS), we made a prospective cohort study. The study subjects consisted of thirty-five patients who exhibited two or more of the conditions of SIRS for more than three consecutive days. They were classified into subgroups of survivors (n = 13) and nonsurvivors (n = 22). The global coagulation and fibrinolytic markers, antithrombin, protein C, and plasminogen activator inhibitor 1 were measured on the day of the diagnosis of SIRS, and also on the 1st, 3rd, and 5th days. The results of these measurements, demographic data, criteria of severity, incidence of MODS were compared between the subgroups. For prediction of patient's death, a receiver operating characteristic (ROC) curve analysis was made. DIC was frequently associated with SIRS patients (29/35, 82.9%). A significant decrease in the DIC score was found in the survivors (p = 0.0001). None of them suffered from DIC on the 5th day. In the nonsurvivors, low levels of protein C and antithrombin and markedly high values of plasminogen activator inhibitor 1 continued up to the 5th day, no improvement of the DIC was observed during the study period and the number of the dysfunctioning organs were significantly higher than in the survivors. Plasminogen activator inhibitor 1 on the 5th day had prognostic value for the prediction of death on the SIRS patients. In conclusion, DIC occurs commonly in patients with SIRS and may be the main determinant for the outcome of these patients. Changes in antithrombin, protein C, and plasminogen activator inhibitor 1 are one of the aggravating factors of MODS. Furthermore, plasminogen activator inhibitor 1 is a good predictor of death in these patients.
为评估弥散性血管内凝血（DIC）的作用，并确定抗凝血酶、蛋白C和纤溶酶原激活物抑制剂1对全身炎症反应综合征（SIRS）患者多器官功能障碍综合征（MODS）及预后的影响，我们进行了一项前瞻性队列研究。研究对象包括35例连续3天以上出现两种或更多SIRS症状的患者。他们被分为存活组（n = 13）和非存活组（n = 22）。在SIRS诊断当天以及第1、3和5天测量了全局凝血和纤溶标志物、抗凝血酶、蛋白C和纤溶酶原激活物抑制剂1。比较了两组之间这些测量结果、人口统计学数据、严重程度标准、MODS发生率。为预测患者死亡，进行了受试者工作特征（ROC）曲线分析。DIC常与SIRS患者相关（29/35，82.9%）。存活组的DIC评分显著降低（p = 0.0001）。第5天时他们均未发生DIC。在非存活组中，蛋白C和抗凝血酶水平较低，纤溶酶原激活物抑制剂1的值在第5天一直显著升高，研究期间未观察到DIC有改善，功能障碍器官的数量显著高于存活组。第5天的纤溶酶原激活物抑制剂1对预测SIRS患者死亡具有预后价值。总之，DIC常见于SIRS患者，可能是这些患者预后的主要决定因素。抗凝血酶、蛋白C和纤溶酶原激活物抑制剂1的变化是MODS的加重因素之一。此外，纤溶酶原激活物抑制剂1是这些患者死亡的良好预测指标。
