CYTOKINES AND PLASMINOGEN-ACTIVATOR INHIBITOR-1 IN POSTTRAUMA DISSEMINATED INTRAVASCULAR COAGULATION - RELATIONSHIP TO MULTIPLE ORGAN DYSFUNCTION SYNDROME

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 (DI G); b) to determine the influence of DIC on the mortality rate, adult respiratory distress syndrome (ARDS), and multiple organ dysfunction s yndrome; 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 pati ents with DIG and 36 of the patients without DIG. Interventions: None. Measurements and main Results: TNF-alpha, IL-1 beta, plasminogen acti vator inhibitor-1 activity, and plasminogen activator inhibitor-1 anti gen concentration were measured on the day of the injury, and on days 1, 3, and 5 after admission. The results of these measurements, demogr aphic data, severity of illness score, mortality rate in the intensive care unit and frequencies of ARDS, multiple organ dysfunction syndrom e, and sepsis were compared according to the occurrence of DIG. DIC pa tients were classified into subgroups of survivors and nonsurvivors, a nd the changes in plasminogen activator inhibitor-1 between subgroups were studied. The Acute Physiology and Chronic Health Evaluation II sc ores, the Injury Severity Scores, and the frequency of ARDS and multip le organ dysfunction syndrome were higher in the DIC patients. The mor tality rate of the DIC patients was higher than the rate of the non-DI G patients (59.0% vs. 13.8%; p = .0009). TNF-alpha and IL-1 beta conce ntrations increased more in the DIC patients than in the non-DIG patie nts. Plasminogen activator inhibitor-1 activity and plasminogen activa tor 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 plasminoge n activator inhibitor-1 for the prediction of death in all of the trau ma patients and the DIC patients was determined on days 3 and 5, respe ctively. No significant correlation was noted between the two cytokine s and plasminogen activator inhibitor-1. Conclusions: In the patients with trauma, DIC is a predictor of ARDS, multiple organ dysfunction sy ndrome,and death. TNF-a and IL-1 beta might be one of the causes of DI G, while plasminogen activator inhibitor-1 may be one of the aggravati ng factors of ARDS and multiple organ dysfunction syndrome. Plasminoge n activator inhibitor-1 is a good predictor of death for posttrauma DI G patients.