Thrombin-activatable fibrinolysis inhibitor and organ dysfunction in disseminated intravascular coagulation associated with sepsis

Introduction Fibrinolytic shutdown plays a pivotalrole in the pathogenesis of multiple organ dysfunction syndrome (MODS) in disseminated intravascular coagulation (DIC). We tested the hypothesis that the levels of thrombin activatable fi brinolysis inhibitor (TAFI) are not suffi cient to overcome fi brinolytic shutdown, thus contributing to MODS and the poor prognosis in sepsis-induced DIC. Methods Fifty patients with sepsis, severe sepsis, or septic shock were enrolled in the study. The DIC was diagnosed based on the Japanese Association for Acute Medicine (JAAM) DIC criteria. The overt DIC scores based on the International Society on Thrombosis and Haemostasis (ISTH) were also calculated. On the day of sepsis diagnosis (day 1), and days 3 and 5, we measured TAFI, soluble fi brin, and global coagulation and fi brinolysis markers. Results The JAAM DIC scores on day 1 and maximum JAAM DIC scores were independent predictors of patient death and MODS, respectively. The JAAM DIC patients, especially those who simultaneously met the ISTH overt DIC criteria, showed lower TAFI antigen levels and activity, and higher levels of soluble fi brin in comparison with non-DIC patients. There were diff erences in the levels of soluble fi brin and TAFI activity between the patients with and without MODS. The fi ndings of stepwise logistic regression and multiple regression analyses suggested that low TAFI activity is an independent predictor of patient death and MODS. A multiple regression analysis also indicated that soluble fi brin negatively correlated with the TAFI activity in DIC patients. Conclusion Thrombin activation results in the consumption of TAFI. Low TAFI activity is involved in the pathogenesis of DIC-induced MODS and poor prognosis. Introduction Anti-endotoxin immunity (AEI) has many biological eff ects but the problem of conjugation and elimination of lipopolysaccharides (LPS) in peritonitis patients is not discussed. We investigated the role of IgA, IgM and IgG in peritonitis and their association with humoral immunity (HI). Methods We investigated 33 patients (male:female = 25:8) with ab-domi nal sepsis (total peritonitis in appendicitis, perforated duodenal ulcer, pancreonecrosis). Anti-endotoxin (AE) antibodies (anti-LPS-IgA, anti-LPS-IgM, anti-LPS-IgG) were determined by original modifi cation of hard-phase immunoenzyme analysis. Escherichia coli K30 LPS was used as antigen for AE antibody detection. The level of general immunoglobulin was determined by the microturbidimetric method with human monospecifi c sera to IgG, IgA and IgM. All data were compared with healthy donors (99 patients). Results A high level of AEI and HI was …