DISSEMINATED INTRAVASCULAR COAGULATION IS A FREQUENT COMPLICATION OF SYSTEMIC INFLAMMATORY RESPONSE SYNDROME

To evaluate the role of disseminated intravascular coagulation (DIG) a nd to determine the influence of antithrombin, protein C, and plasmino gen activator inhibitor 1 on multiple organ dysfunction syndrome (MODS ) and outcome in patients with systemic inflammatory response syndrome (SIRS), we made a prospective cohort study. The study subjects consis ted of thirty-five patients who exhibited two or more of the condition s of SIRS for more than three consecutive days. They were classified i nto subgroups of survivors (n = 13) and nonsurvivors (n = 22). The glo bal coagulation and fibrinolytic markers, antithrombin, protein C, and plasminogen activator inhibitor 1 were measured on the day of the dia gnosis of SIRS, and also on the 1st, 3rd, and 5th days. The results of these measurements, demographic data, criteria of severity, incidence of MODS were compared between the subgroups. For prediction of patien t's death, a receiver operating characteristic (ROC) curve analysis wa s made. DIC was frequently associated with SIRS patients (29/35, 82.9% ). A significant decrease in the DIC score was found in the survivors (p = 0.0001). None of them suffered from DIC on the 5th day. In the no nsurvivors, low levels of protein C and antithrombin and markedly high values of plasminogen activator inhibitor 1 continued up to the 5th d ay, no improvement of the DIC was observed during the study period and the number of the dysfunctioning organs were significantly higher tha n in the survivors. Plasminogen activator inhibitor 1 on the 5th day h ad prognostic value for the prediction of death on the SIRS patients. In conclusion, DIC occurs commonly in patients with SIRS and may be th e main determinant for the outcome of these patients. Changes in antit hrombin, protein C, and plasminogen activator inhibitor 1 are one of t he aggravating factors of MODS. Furthermore, plasminogen activator inh ibitor 1 is a good predictor of death in these patients.