Contrasting Post-Traumatic Serial Changes for D-Dimer and PAI-1 in Critically Injured Patients

• Published in: Thrombosis research Vol. 94; no. 3; pp. 175 - 185
• Main Authors: Chen, James P., Rowe, Dennis W., Enderson, Blaine L.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Ltd 01-05-1999; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Enzyme-Linked Immunosorbent Assay; Female; Fibrin D-dimer; Fibrin Fibrinogen Degradation Products - metabolism; Humans; Lung Diseases - blood; Male; Medical sciences; Miscellaneous; Pathologic thrombosis; Plasminogen Activator Inhibitor 1 - blood; Plasminogen activator inhibitor-1; Plasminogen Activators - metabolism; Pneumonia - blood; Respiratory Tract Diseases - blood; Trauma patients; Traumas. Diseases due to physical agents; Wounds and Injuries - blood; ICU, intensive care unit; RBC, red blood cell; ARDS, adult respiratory distress syndrome; PRBC, packed red blood cell; PE, pulmonary embolism; AIS,injury score; SR, Simpli Red; Mab, monoclonal antibody; Fibrin D-dimer; ISS, injury severity score; LAT, latex agglutination test; Trauma patients; Plasminogen activator inhibitor-1; ELISA, enzyme-linked immunosorbent assay; FDP, fibrin degradation product, PAI-1, plasminogen activator inhibitor-1; Pathologic thrombosis; NHP, normal human plasma; DVT, deep vein thrombosis; t-PA, tissue plasminogen activator; PA, plasminogen activator; Human; Prognosis; Critically ill; Cardiovascular disease; D dimer; Thrombosis; Trauma; Vascular disease; Plasminogen activator inhibitor 1; Enzymatic activity; Hemostasis; Complication; Predictive factor
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/S0049-3848(98)00211-4

We measured D-dimer and plasminogen activator inhibitor-1 (PAI-1) activity in 45 trauma patients to assess their efficacy in predicting the post-traumatic hemostatic perturbations. We found the correlation between D-dimer measured by Simpli Red test and ELISA to be highly significant
p=0.0001
. The D-dimer ELISA indicated that the serial changes of D-dimer after trauma were variable. However, the increases of D-dimer were associated with clinical conditions of the patient, such as trauma surgery, infections, or thrombotic complications. A significant correlation was found for D-dimer levels measured by ELISA versus the injury severity score (ISS) in all the trauma patients on day 1
p=0.0153
and on day 2
p=0.0495
. The PAI-1 activity was increased at admission and showed a progessive decline from day 2 onward, and the correlation for the daily decline of PAI-1 was highly significant
p=0.0001
. The PAI-1 activity and plasminogen activator activity showed a significant negative correlation on days 1, 2, and 3. PAI-1 activity correlated moderately with D-dimer level only on day 1
p=0.0569
. Three out of forty-five patients developed thrombotic complications: one patient who died from pulmonary embolism and two patients who developed adult respiratory distress syndrome (ARDS). In summary: 1) PAI-1 activity and D-dimer exhibited contrasting serial changes after trauma. 2) There was also a negative correlation between PAI-1 activity and PA activity. 3) A significant correlation of D-dimer with ISS confirms, as might be anticipated, that there is increased activation of the coagulation mechanism in severe injury, and suggests that D-dimer levels may prove useful to screen for patients at strong risks of thrombotic complications.