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Post# of 19309
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DewDiligence

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Re: DewDiligence post# 3714

Tuesday, 11/13/2007 6:15:25 PM

Tuesday, November 13, 2007 6:15:25 PM

Post# of 19309
AT in SIRS / Sepsis:

This paper says a low level of antithrombin is
the best known predictor of organ failure in SIRS.
(SIRS is a superset of sepsis in which the cause of
trauma is something other than a discernable infection.)

http://tinyurl.com/yrthon

>>
Predicting the Severity of Systemic Inflammatory Response Syndrome (SIRS)-Associated Coagulopathy With Hemostatic Molecular Markers and Vascular Endothelial Injury Markers

J Trauma. 2007 Nov;63(5):1093-1098.
.
Iba T, Gando S, Murata A, Kushimoto S, Saitoh D, Eguchi Y, Ohtomo Y, Okamoto K, Koseki K, Mayumi T, Ikeda T, Ishhikura H, Ueyama M, Ogura Y, Endo S, Shimazaki S; the Japanese Association for Acute Medicine Disseminated Intravascular Coagulation Study Group.

Division Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (S.G.), Hokkaido University Graduate School of Medicine; Department of Trauma & Critical Care Medicine (A.M.), Kyorin University School of Medicine; Department of Emergency & Critical Care Medicine (S.K.), Nippon Medical School; Department of Traumatology and Critical Care Medicine (D.S.), National Defense Medical College; Critical and Intensive Care Medicine (Y.E.), Shiga University of Medical Science; Department of Critical Care and Traumatology (Y.O.), National Disaster Medical Center; Department of Surgery 1 (K.O.), School of Medicine, University of Occupational and Environmental Health; Emergency and Critical Care Medicine (K.K.), Kawaguchi Municipal Medical Center; Department of Emergency Medicine and Intensive Care (T.M.), Nagoya University School of Medicine; Department of Critical Care and Emergency Medicine (T.I.), Tokyo Medical University Hachioji Medical Center; Department of Emergency and Critical Care Medicine (H.I.), National Hospital Organization, Kyoto Medical Center; Shakaihoken Cyukyo Hospital (M.U.); Department of Traumatology and Acute Critical Care Medicine (H.O.), Osaka University Medical School; Department of Critical Care Medicine (S.E.), School of Medicine, Iwate Medical University; and Department of Trauma & Critical Care Medicine (S.S.), Kyorin University School of Medicine.

INTRODUCTION: The changes in biomarkers of coagulation or fibrinolysis, anticoagulation, inflammation, and endothelial damage occur in patients with systemic inflammatory response syndrome (SIRS). The purpose of this study is to assess the prognostic value of these markers in patients with SIRS-associated hypercoagulopathy.

METHODS: Sixty-six SIRS patients with a platelet count less than 15.0 x 10/mm in three university hospital intensive care units were enrolled in this prospective, comparative study. Blood samples were obtained on day 0 and day 2. Twelve hemostatic, inflammatory, and vascular endothelial indices were measured and the data were compared between the severe group (patients with a total maximum Sequential Organ Failure Assessment score of 10 or more and nonsurvivors; n = 25) and the less-severe group (Sequential Organ Failure Assessment score <10; n = 41).

RESULTS: Significant changes between the groups were observed in platelet count, fibrin or fibrinogen degradation products, interleukin-6, soluble thrombomodulin, antithrombin (AT) activity, and protein C activity, both on day 0 and on day 2. In contrast, the d-dimer, soluble fibrin, plasmin-alpha2-antiplasmin complex, and E-selectin levels were higher in the severe group only on day 2. No significant difference was seen regarding the thrombin-AT complex and total plasminogen activator inhibitor on both days. A comparison of the areas under the receiver operating characteristic curve revealed the AT activity to be the best predictor of a progression of organ dysfunction.

CONCLUSION: The changes in some hemostatic molecular markers and vascular endothelial markers were conspicuous in patients with organ dysfunction. The AT activity is considered to be the most useful predictor of organ dysfunction.
<<

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