Cytokines and plasminogen activator inhibitor-1 in posttrauma disseminated intravascular coagulation: Relationship to multiple organ dysfunction syndrome

• Published in: Critical care medicine Vol. 23; no. 11; pp. 1835 - 1842
• Main Authors: Gando, Satoshi, Nakanishi, Yoshimi, Tedo, Ichiro
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Williams & Wilkins 01-11-1995; Lippincott
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; APACHE; Biological and medical sciences; Case-Control Studies; Disseminated Intravascular Coagulation - blood; Disseminated Intravascular Coagulation - complications; Disseminated Intravascular Coagulation - mortality; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Humans; Intensive care medicine; Intensive Care Units; Interleukin-1 - blood; Male; Medical sciences; Multiple Organ Failure - blood; Multiple Organ Failure - etiology; Plasminogen Activator Inhibitor 1 - blood; Predictive Value of Tests; Prognosis; Prospective Studies; Respiratory Distress Syndrome, Adult - blood; Respiratory Distress Syndrome, Adult - diagnosis; Respiratory Distress Syndrome, Adult - etiology; Tumor Necrosis Factor-alpha - metabolism; Wounds and Injuries - blood; Wounds and Injuries - complications; Wounds and Injuries - mortality; Human; Disseminated intravascular coagulopathy; Urinary system disease; Prognosis; Respiratory disease; Cytokine; Multiple organ failure; Cardiovascular disease; Hemopathy; Adult respiratory distress syndrome; Digestive diseases; Inhibitor; Coagulopathy
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/00003246-199511000-00009

OBJECTIVES a) To investigate the relationships between tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), plasminogen activator inhibitor-1, and disseminated intravascular coagulation (DIC); b) to determine the influence of DIC on the mortality rate, adult respiratory distress syndrome (ARDS), and multiple organ dysfunction syndrome; and c) to find a useful prognostic index for outcome.
DESIGN Prospective, case-control study.
SETTING General intensive care unit (tertiary care center) in a city hospital serving a population of 1.5 million people.
PATIENTS Fifty-eight trauma patients; 22 of the patients with DIC and 36 of the patients without DIC.
INTERVENTIONS None.
MEASUREMENTS AND MAIN RESULTS TNF-alpha, IL-1 beta, plasminogen activator inhibitor-1 activity, and plasminogen activator inhibitor-1 antigen concentration were measured on the day of the injury, and on days 1, 3, and 5 after admission. The results of these measurements, demographic data, severity of illness score, mortality rate in the intensive care unit and frequencies of ARDS, multiple organ dysfunction syndrome, and sepsis were compared according to the occurrence of DIC. DIC patients were classified into subgroups of survivors and nonsurvivors, and the changes in plasminogen activator inhibitor-1 between subgroups were studied. The Acute Physiology and Chronic Health Evaluation II scores, the Injury Severity Scores, and the frequency of ARDS and multiple organ dysfunction syndrome were higher in the DIC patients. The mortality rate of the DIC patients was higher than the rate of the non-DIC patients (59.0% vs. 13.8%; p equals .0009). TNF-alpha and IL-1 beta concentrations increased more in the DIC patients than in the non-DIC patients. Plasminogen activator inhibitor-1 activity and plasminogen activator inhibitor-1 antigen concentrations in the DIC patients, especially those values in the nonsurvivors, continued to be markedly high up to day 5 of admission. The most favorable prognostic value of plasminogen activator inhibitor-1 for the prediction of death in all of the trauma patients and the DIC patients was determined on days 3 and 5, respectively. No significant correlation was noted between the two cytokines and plasminogen activator inhibitor-1.
CONCLUSIONS In the patients with trauma, DIC is a predictor of ARDS, multiple organ dysfunction syndrome, and death. TNF-alpha and IL-1 beta might be one of the causes of DIC, while plasminogen activator inhibitor-1 may be one of the aggravating factors of ARDS and multiple organ dysfunction syndrome. Plasminogen activator inhibitor-1 is a good predictor of death for posttrauma DIC patients.(Crit Care Med 1995; 23:1835-1842)