DETERMINATION OF PLASMA SOLUBLE FIBRIN USING A NEW ELISA METHOD IN PATIENTS WITH DISSEMINATED INTRAVASCULAR COAGULATION

We measured plasma levels of soluble fibrin (SF) in 98 patients suspec ted of having disseminated intravascular coagulation (DIG) using a new ly developed enzyme-linked immunosorbent assay (ELISA) and investigate d the correlations between SF determinations and measurements of other hemostatic molecular markers to determine the diagnostic usefulness o f determinations of SF. Patients were classified into four groups acco rding to their clinical and laboratory findings: overt DIC (n = 33), s ubclinical DIC (n = 23), hypercoagulability (n = 22), and non-D1C (n = 20). SF levels were significantly higher in patients with overt DIG c ompared with the other three groups and were significantly higher in t he subclinical DIC and hypercoagulability groups compared with the non -D1C patients, SF levels increased significantly with each increase in the clinical stage. Although levels of thrombin-antithrombin HI compl ex (TAT), prothrombin fragment 1 + 2 (PF1+2), cross-linked fibrin degr adation products (XDP), and plasmin-antiplasmin complex (PAP) were sig nificantly increased in patients with overt DIC compared with non-DIG patients, the values of these hemostatic molecular markers did not con sistently show an increase in association with advances in the disease stage. Plasma levels of SF in patients with overt DIC showed a positi ve correlation with levels of TAT, XDP, and FDP(E), but not with PF1+2 and PAP. Analysis of receiver-operating characteristic curves showed that the sensitivity and specificity of SF-were similar to those of XD P for diagnosis of DIG. The sensitivity and specificity of SF for diag nosis of overt DIC were both above 90% when the cut-off value was set at 65 mu g/ml. Plasma levels of SF were also increased in patients wit h extravascular fibrin formation without DIG. Our findings suggest tha t measurement of plasma levels of SF by this ELISA method is useful fo r the diagnosis of DIC and the evaluation of the patient's clinical st atus. (C) 1996 Wiley-Liss, Inc.