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Close relationship of tissue plasminogen activator-plasminogen activator inhibitor-1 complex with multiple organ dysfunction syndrome investigated by means of the artificial pancreas.

Hoshino M, Haraguchi Y, Hirasawa H, Sakai M, Saegusa H, Hayashi K, Horita N, Ohsawa H - Crit Care (2001)

Bottom Line: Thrombomodulin (TM) was measured as the indicator of ECI.The MOF score and blood TM levels were positively correlated with DIC score, thrombin-AT-III complex and tPA-PAI-1 complex, and negatively correlated with blood platelet count.The treatment for reducing hypercoagulability and ECA/ECI were thought to be justified as one of the therapies for acutely ill septic patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Intensive and Critical Care Medicine, Tokyo Police Hospital, Chiyoda-ku, Tokyo, Japan. noel2000@aioros.ocn.ne.jp

ABSTRACT

Background: Glucose tolerance (GT) has not been taken into consideration in investigations concerning relationships between coagulopathy and multiple organ dysfunction syndrome (MODS), and endothelial cell activation/endothelial cell injury (ECA/ECI) in septic patients, although coagulopathy is known to be influenced by blood glucose level. We investigated those relationships under strict blood glucose control and evaluation of GT with the glucose clamp method by means of the artificial pancreas in nine septic patients with glucose intolerance. The relationships between GT and blood stress related hormone levels (SRH) were also investigated.

Methods: The amount of metabolized glucose (M value), as the parameter of GT, was measured by the euglycemic hyperinsulinemic glucose clamp method, in which the blood glucose level was clamped at 80 mg/dl under a continuous insulin infusion rate of 1.12 mU/kg per min, using the artificial pancreas, STG-22. Multiple organ failure (MOF) score was calculated using the MOF criteria of Japanese Association for Critical Care Medicine. Regarding coagulopathy, the following parameters were used: disseminated intravascular coagulation (DIC) score (calculated from the DIC criteria of the Ministry of Health and Welfare of Japan) and the parameters used for calculating DIC score, protein-C, protein-S, plasminogen, antithrombin III (AT-III), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator-PAI-1 (tPA-PAI-1) complex. Thrombomodulin (TM) was measured as the indicator of ECI.

Results: There were no significant correlations between M value and SRH, parameters indicating coagulopathy and the MOF score. The MOF score and blood TM levels were positively correlated with DIC score, thrombin-AT-III complex and tPA-PAI-1 complex, and negatively correlated with blood platelet count.

Conclusions: GT was not significantly related to SRH, coagulopathy and MODS under strict blood glucose control. Hypercoagulability was closely related to MODS and ECI. Among the parameters indicating coagulopathy, tPA-PAI-1 complex, which is considered to originate from ECA, seemed to be a sensitive parameter of MODS and ECI, and might be a predictive marker of MODS. The treatment for reducing hypercoagulability and ECA/ECI were thought to be justified as one of the therapies for acutely ill septic patients.

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Correlations between mMOF score and parameters related to coagulation and fibrinolysis. The mMOF score (mMOF score = MOF score - the points of coagulopathy of MOF score) was positively correlated with (a) the DIC score, (b) TAT and (d) tPA-PAI-1 complex, and (c) negatively correlated with PLT.
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Figure 2: Correlations between mMOF score and parameters related to coagulation and fibrinolysis. The mMOF score (mMOF score = MOF score - the points of coagulopathy of MOF score) was positively correlated with (a) the DIC score, (b) TAT and (d) tPA-PAI-1 complex, and (c) negatively correlated with PLT.

Mentions: The MOF score was strongly correlated with the DIC score (r = 0.75, P < 0.002), TAT (r = 0.72, P < 0.002), tPA-PAI-1 complex (r = 0.69, P < 0.002) and PLT (r = -0.68, P < .002) among parameters related with coagulation and fibrinolysis (Table 7). Because three of the aforementioned parameters (not the tPA-PAI-1 complex) are used for calculating the MOF score, however, correlations between the mMOF score, in which the points of coagulopathy of the MOF score are excluded, and parameters related to coagulation and fibrinolysis were also analyzed. The mMOF score was still strongly correlated with TAT (r = 0.69, P < 0.002), DIC score (r = 0.66, P < 0.002), PLT (r = -0.65, P < 0.003) and tPA-PAI-1 complex (r = 0.62, P < 0.005) (Table 8; Fig. 2).


Close relationship of tissue plasminogen activator-plasminogen activator inhibitor-1 complex with multiple organ dysfunction syndrome investigated by means of the artificial pancreas.

Hoshino M, Haraguchi Y, Hirasawa H, Sakai M, Saegusa H, Hayashi K, Horita N, Ohsawa H - Crit Care (2001)

Correlations between mMOF score and parameters related to coagulation and fibrinolysis. The mMOF score (mMOF score = MOF score - the points of coagulopathy of MOF score) was positively correlated with (a) the DIC score, (b) TAT and (d) tPA-PAI-1 complex, and (c) negatively correlated with PLT.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC30714&req=5

Figure 2: Correlations between mMOF score and parameters related to coagulation and fibrinolysis. The mMOF score (mMOF score = MOF score - the points of coagulopathy of MOF score) was positively correlated with (a) the DIC score, (b) TAT and (d) tPA-PAI-1 complex, and (c) negatively correlated with PLT.
Mentions: The MOF score was strongly correlated with the DIC score (r = 0.75, P < 0.002), TAT (r = 0.72, P < 0.002), tPA-PAI-1 complex (r = 0.69, P < 0.002) and PLT (r = -0.68, P < .002) among parameters related with coagulation and fibrinolysis (Table 7). Because three of the aforementioned parameters (not the tPA-PAI-1 complex) are used for calculating the MOF score, however, correlations between the mMOF score, in which the points of coagulopathy of the MOF score are excluded, and parameters related to coagulation and fibrinolysis were also analyzed. The mMOF score was still strongly correlated with TAT (r = 0.69, P < 0.002), DIC score (r = 0.66, P < 0.002), PLT (r = -0.65, P < 0.003) and tPA-PAI-1 complex (r = 0.62, P < 0.005) (Table 8; Fig. 2).

Bottom Line: Thrombomodulin (TM) was measured as the indicator of ECI.The MOF score and blood TM levels were positively correlated with DIC score, thrombin-AT-III complex and tPA-PAI-1 complex, and negatively correlated with blood platelet count.The treatment for reducing hypercoagulability and ECA/ECI were thought to be justified as one of the therapies for acutely ill septic patients.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Intensive and Critical Care Medicine, Tokyo Police Hospital, Chiyoda-ku, Tokyo, Japan. noel2000@aioros.ocn.ne.jp

ABSTRACT

Background: Glucose tolerance (GT) has not been taken into consideration in investigations concerning relationships between coagulopathy and multiple organ dysfunction syndrome (MODS), and endothelial cell activation/endothelial cell injury (ECA/ECI) in septic patients, although coagulopathy is known to be influenced by blood glucose level. We investigated those relationships under strict blood glucose control and evaluation of GT with the glucose clamp method by means of the artificial pancreas in nine septic patients with glucose intolerance. The relationships between GT and blood stress related hormone levels (SRH) were also investigated.

Methods: The amount of metabolized glucose (M value), as the parameter of GT, was measured by the euglycemic hyperinsulinemic glucose clamp method, in which the blood glucose level was clamped at 80 mg/dl under a continuous insulin infusion rate of 1.12 mU/kg per min, using the artificial pancreas, STG-22. Multiple organ failure (MOF) score was calculated using the MOF criteria of Japanese Association for Critical Care Medicine. Regarding coagulopathy, the following parameters were used: disseminated intravascular coagulation (DIC) score (calculated from the DIC criteria of the Ministry of Health and Welfare of Japan) and the parameters used for calculating DIC score, protein-C, protein-S, plasminogen, antithrombin III (AT-III), plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator-PAI-1 (tPA-PAI-1) complex. Thrombomodulin (TM) was measured as the indicator of ECI.

Results: There were no significant correlations between M value and SRH, parameters indicating coagulopathy and the MOF score. The MOF score and blood TM levels were positively correlated with DIC score, thrombin-AT-III complex and tPA-PAI-1 complex, and negatively correlated with blood platelet count.

Conclusions: GT was not significantly related to SRH, coagulopathy and MODS under strict blood glucose control. Hypercoagulability was closely related to MODS and ECI. Among the parameters indicating coagulopathy, tPA-PAI-1 complex, which is considered to originate from ECA, seemed to be a sensitive parameter of MODS and ECI, and might be a predictive marker of MODS. The treatment for reducing hypercoagulability and ECA/ECI were thought to be justified as one of the therapies for acutely ill septic patients.

Show MeSH
Related in: MedlinePlus