A Prospective Analysis of Disseminated Intravascular Coagulation in Patients with Infections

Seki, Yoshinobu; Wada, Hideo; Kawasugi, Kazuo; Okamoto, Kohji; Uchiyama, Toshimasa; Kushimoto, Shigeki; Hatada, Tsuyoshi; Matsumoto, Takashi; Imai, Hiroshi; subcommittee, Dic

doi:10.2169/internalmedicine.52.0571

Cited by 15 publications

(9 citation statements)

References 33 publications

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“…This was in agreement with Shapiro et al [21] and Seki et al [22] as they found that Plasma levels were significantly higher in patients with severe sepsis than in the less severe group.…”

Section: Discussionsupporting

confidence: 92%

Study of Plasminogen Activator Inhibitor-1 (PAI-1) as Prognostic Marker in Sepsis

Elnomany

Hodeib

Elbaradey

et al. 2021

JAMMR

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Background: Sepsis is an unorganized host response to infection that is manifested by the failure of organs and DIC and systemic coagulation due to failure of Plasmin as an important fibrin lytic protein that is regulated by plasminogen activators and inhibitors. Our theory is that elevated PAI-1 may have a role in multi-system organ failure in patients with septicemia and systemic coagulopathy. Aim: to evaluate plasminogen activator inhibitor-1 as a prognostic factor in patients with septicemia and DIC. Patients and Methods: 60 cases with septicemia and in shock, in addition to 20 healthy individuals. Cases were selected from surgical ICU, Tanta University hospitals. Normal healthy subjects were matched by age and gender with the patients' group. Results: Respiratory system and urinary tract infections, were the most common infections and high SOFA and APACHE scores in the selected cases. The hematological findings in septic patients are anemia, thrombocytopenia, and leukocytosis. There was a significant increase in urea, creatinine, SGOT, SGPT levels, and CRP in patient groups. Higher levels of PAI-1 in cases suffering sepsis. An increased mortality rate after 28 days of follow-up was noticeable in cases with established septic shock compared to other patient groups in Tanta university surgical intensive care. We found a direct correlation between PAI-1and SOFA, APACHE, bilirubin, creatinine, PT, APTT, and Procalcitonin. Conclusions: PAI-1 level has a prognostic value in cases with infections or septicemia presented to our emergency center.

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“…This was in agreement with Shapiro et al [21] and Seki et al [22] as they found that Plasma levels were significantly higher in patients with severe sepsis than in the less severe group.…”

Section: Discussionsupporting

confidence: 92%

Study of Plasminogen Activator Inhibitor-1 (PAI-1) as Prognostic Marker in Sepsis

Elnomany

Hodeib

Elbaradey

et al. 2021

JAMMR

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“…tings, DIC was reported as an independent predictor of organ dysfunction, including acute renal dysfunction (16)(17)(18). Therefore, renal function should be considered when treating sepsis patients with renally excreted drugs.…”

Section: Pharmacokinetics Of Recombinant Human Soluble Thrombomodulinmentioning

confidence: 99%

Pharmacokinetics of recombinant human soluble thrombomodulin in disseminated intravascular coagulation patients with acute renal dysfunction

Hayakawa¹,

Kushimoto²,

Watanabe³

et al. 2017

Thromb Haemost

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SummaryRecombinant human soluble thrombomodulin (ART-123) is a novel anticoagulant for patients with disseminated intravascular coagulation (DIC). It is widely used in clinical settings throughout Japan. Furthermore, a global Phase 3 study is currently being conducted. In healthy subjects, ART-123 is excreted mainly via the kidneys. Therefore, ART-123 dose decrease was recommended in DIC patients with severe renal dysfunction. However, the pharmacokinetics of ART-123 in DIC patients with severe acute renal dysfunction has not been elucidated. In an open-label, multicentre, prospective, clinical pharmacological study, we investigated the pharmacokinetics and safety of ART-123 upon repeated administration to DIC patients. ART-123 was administered to patients at a dose of 130 or 380 U/kg/day for six consecutive days. Plasma concentrations of ART-123 were measured at 21 time points until eight days after the final administration. Urinary excretion rates during the first 24 hours (h) were calculated. Patient renal functions were evaluated by measuring 24-h creatinine clearance (Ccr). Forty-three patients were enrolled in the present study. The urinary excretion rates of ART-123 correlated closely with 24-h Ccr. Total body clearance of ART-123 was also weakly related with 24-h Ccr. However, the plasma concentrations of ART-123 were not considerably different among patients with different renal function. Two patients had subcutaneous haemorrhage as an adverse event related to ART-123. In conclusion, plasma concentrations of ART-123 may not be different among patients with different renal functions. ART-123 was well tolerated in these patients.

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“…Endothelial cells, platelets, but in some cases also leucocytes and cancer cells can participate in the genesis of the process leading to DIC by releasing pro-inflammatory cytokines, propagating the activation of coagulation on their surface or inducing tissue factor (TF) expression on their membrane 10,[22][23][24][25][26][27][28] . A systemic inflammatory response that is associated with markedly increased circulating pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-1 (IL-1) and interleukin-6 (IL-6) can lead to exaggerated expression of TF by leukocyte and endothelial cells 24 .…”

Section: What Are the Mechanisms Leading To Dic During Pregnancy?mentioning

confidence: 99%

Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management

Erez

Mastrolia

Thachil

2015

American Journal of Obstetrics and Gynecology

120

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A Prospective Analysis of Disseminated Intravascular Coagulation in Patients with Infections

Cited by 15 publications

References 33 publications

Study of Plasminogen Activator Inhibitor-1 (PAI-1) as Prognostic Marker in Sepsis

Study of Plasminogen Activator Inhibitor-1 (PAI-1) as Prognostic Marker in Sepsis

Pharmacokinetics of recombinant human soluble thrombomodulin in disseminated intravascular coagulation patients with acute renal dysfunction

Disseminated intravascular coagulation in pregnancy: insights in pathophysiology, diagnosis and management

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