Changes in Plasma Levels of Natural Anticoagulants in Disseminated Intravascular Coagulation: High Prognostic Value of Antithrombin and Protein C in Patients with Underlying Sepsis or Severe Infection
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Background: Dysfunctional natural anticoagulant systems enhance intravascular fibrin for- mation in disseminated intravascular coagulation (DIC), and plasma levels of natural anti- coagulants can be used in the diagnosis and prognosis of DIC. Herein, the diagnostic value of 4 natural anticoagulants was assessed, and the prognostic value of antithrombin and protein C were validated in a large population. Methods: Part 1 study included 126 patients with clinically suspected DIC and estimated plasma levels of 4 candidate anticoagulant proteins: antithrombin, protein C, protein S, and protein Z. Part 2 comprised 1,846 patients, in whom plasma antithrombin and protein C levels were compared with other well-known DIC markers according to the underlying dis- eases. The 28-day mortality rate was used to assess prognostic outcome. Results: Antithrombin and protein C showed higher areas under the ROC curve than pro- tein S and protein Z. In part 2 of the study, antithrombin and protein C levels significantly correlated with DIC score, suggesting that these factors are good indicators of DIC severity. Antithrombin and protein C showed significant prognostic power in Kaplan–Meier analyses. In patients with sepsis/severe infection, antithrombin and protein C showed higher hazard ratios than D-dimer. Platelet count showed the highest hazard ratio in patients with hemato- logic malignancy. In patients with liver disease, the hazard ratio for antithrombin levels was significantly high. Conclusions: Decreased plasma anticoagulant levels reflect florid consumption of the phys- iologic defense system against DIC-induced hypercoagulation. Plasma antithrombin and protein C levels are powerful prognostic markers of DIC, especially in patients with sepsis/ severe infection.
Abstract
Background: Dysfunctional natural anticoagulant systems enhance intravascular fibrin for- mation in disseminated intravascular coagulation (DIC), and plasma levels of natural anti- coagulants can be used in the diagnosis and prognosis of DIC. Herein, the diagnostic value of 4 natural anticoagulants was assessed, and the prognostic value of antithrombin and protein C were validated in a large population. Methods: Part 1 study included 126 patients with clinically suspected DIC and estimated plasma levels of 4 candidate anticoagulant proteins: antithrombin, protein C, protein S, and protein Z. Part 2 comprised 1,846 patients, in whom plasma antithrombin and protein C levels were compared with other well-known DIC markers according to the underlying dis- eases. The 28-day mortality rate was used to assess prognostic outcome. Results: Antithrombin and protein C showed higher areas under the ROC curve than pro- tein S and protein Z. In part 2 of the study, antithrombin and protein C levels significantly correlated with DIC score, suggesting that these factors are good indicators of DIC severity. Antithrombin and protein C showed significant prognostic power in Kaplan–Meier analyses. In patients with sepsis/severe infection, antithrombin and protein C showed higher hazard ratios than D-dimer. Platelet count showed the highest hazard ratio in patients with hemato- logic malignancy. In patients with liver disease, the hazard ratio for antithrombin levels was significantly high. Conclusions: Decreased plasma anticoagulant levels reflect florid consumption of the phys- iologic defense system against DIC-induced hypercoagulation. Plasma antithrombin and protein C levels are powerful prognostic markers of DIC, especially in patients with sepsis/ severe infection.
참고문헌 (18)
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