Document Detail


Cytokines and plasminogen activator inhibitor-1 in posttrauma disseminated intravascular coagulation: relationship to multiple organ dysfunction syndrome.
MedLine Citation:
PMID:  7587259     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 = .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.
Authors:
S Gando; Y Nakanishi; I Tedo
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  23     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1995 Nov 
Date Detail:
Created Date:  1995-12-20     Completed Date:  1995-12-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1835-42     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency and Critical Care Medicine, Sapporo City General Hospital, Japan.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Case-Control Studies
Disseminated Intravascular Coagulation / blood*,  complications*,  mortality
Female
Humans
Intensive Care Units
Interleukin-1 / blood*
Male
Multiple Organ Failure / blood*,  etiology
Plasminogen Activator Inhibitor 1 / blood*
Predictive Value of Tests
Prognosis
Prospective Studies
Respiratory Distress Syndrome, Adult / blood,  diagnosis,  etiology
Tumor Necrosis Factor-alpha / metabolism*
Wounds and Injuries / blood*,  complications*,  mortality
Chemical
Reg. No./Substance:
0/Interleukin-1; 0/Plasminogen Activator Inhibitor 1; 0/Tumor Necrosis Factor-alpha

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