CYTOKINES, SOLUBLE THROMBOMODULIN AND DISSEMINATED INTRAVASCULAR COAGULATION IN PATIENTS WITH SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

To investigate the relationships between tumor necrosis factor-alpha ( TNF), interleukin-1 beta (IL-1B), soluble thrombomodulin (TM), and dis seminated intravascular coagulation (DIC) in patients with systemic in flammatory response syndrome (SIRS), twenty-nine SIRS patients were cl assified into three groups; 4 patients without DIC, 8 DIC patients who recovered, and 17 DIC patients who did not recover. Serum TNF, IL-1B, and soluble TM were measured on the day of the diagnosis of SIRS; and also on the 1st, 3rd, 5th days. All of the DIC patients had multiple organ dysfunction syndrome (MODS) and the number of the dysfunctioning organs showed significant differences between the groups (p = .0017). All of the patients who did not recover from DIC died. The serum solu ble TM level was higher in the patients without DIC recovery than in e ither the DIC recovery patients or the non DIC patients throughout the study period. In DIC patients who did not recover, there were signifi cant correlations between soluble TM and TNF (r(2) 0.205, p = .0003) o r IL-1B (r(2) = 0.157, p = .0036). In conclusion, the DIC being associ ated with endothelial injury is an important pathogenetic factor for M ODS and is a main determinant of the outcome of SIRS patients. TNF and IL-1B might be involved in the cause of this endothelial injury. The soluble TM is a good predictor of organ dysfunction and also of a poor prognosis.