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Increased mortality in systemic inflammatory response syndrome patients with high levels of coagulation factor VIIa.
MedLine Citation:
PMID:  24131789     Owner:  NLM     Status:  Publisher    
BACKGROUND: The tissue factor (TF)-Factor VIIa (FVIIa) complex has a pivotal role in inflammatory and coagulation responses in patients with Systemic Inflammatory Response Syndrome (SIRS) and sepsis. Since zymogen FVII (FVII) and FVIIa compete for binding to TF, their plasma levels determine if a catalytically active TF-FVIIa complex will be formed.
OBJECTIVE: To study mortality in SIRS patients as a function of FVIIa and VII levels in plasma.
METHODS: A cohort study of 275 patients presenting with SIRS, aged 18 or older and an anticipated Intensive Care Unit (ICU)-stay of at least 24 hours. FVIIa was measured using a novel, quantitative assay that recognizes FVIIa, but not FVII. All-cause hospital mortality was followed over a period of 60 days.
RESULTS: The percentage of FVII measured as FVIIa was higher in non-survivors than survivors (2.8%, IQR=1-5.5% vs. 1.5%, IQR=0.6-3.3%; P=0.034). High levels of FVIIa were associated with decreased 60-day cumulative survival (62% vs 81%, P=0.030); the opposite was observed for FVII (84% vs 76%, P=0.039). Patients with high-FVIIa and low-FVII levels had a three-fold increased hazard ratio (HR) compared to the patients that had low-FVIIa and high-FVII levels ([HR]=3.24, 95% Confidence Interval [CI]=1.41-7.36). This association persisted after adjusting for the APACHE IV score (adjusted HR=2.75, 95% CI=1.2-6.27).
CONCLUSIONS: SIRS patients with high-FVIIa and low-FVII on admission have an increased mortality risk, an association that is independent from the parameters included in the APACHE IV score. This article is protected by copyright. All rights reserved.
Agon Hyseni; Hans Kemperman; Dylan W de Lange; Philip G de Groot; Matthijs Linssen; Jozef Kesecioglu; Ton Lisman; Mark Roest
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-17
Journal Detail:
Title:  Journal of thrombosis and haemostasis : JTH     Volume:  -     ISSN:  1538-7836     ISO Abbreviation:  J. Thromb. Haemost.     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101170508     Medline TA:  J Thromb Haemost     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
Department of Clinical Chemistry and Hematology, University of Utrecht, University Medical Center Utrecht.
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