SOLUBLE FIBRIN - A PREDICTOR FOR THE DEVELOPMENT AND OUTCOME OF MULTIPLE ORGAN FAILURE

According to our hypothesis ICU patients with signs of early hypercoag ulation should develop more organ system failures that result in highe r mortality rates and longer treatment periods. Routine coagulation te sts are unreliable for measuring early hypercoagulation. Methods: Solu ble fibrin (SF), reflecting hypercoagulation, was assessed at an early stage in 101 ICU patients. A spectrophotometric method using chromoge nic peptide substrates was employed. The patients were divided into fo ur groups, depending on the patient's highest level of SF within the f irst week after admission: Group I (21 patients), SF < 15 nmol/L (refe rence level); Group II (27 patients), SF 15-29 nmol/L; Group III (26 p atients), SF 30-50 nmol/L and Group IV (27 patients), SF > 50 nmol/L. The number of secondary failing organ systems and the ventilator time, ICU time and mortality rates were recorded. Results: There was a sign ificant increase in the number of secondary failing organ systems (P < 0.0001) and a significantly increased mortality for the groups with h igher SF (P = 0.01). There was a mean of 0.6, 1.3, 2.4, and 3.4 failin g organs and a mortality of 14%, 22%, 30%, and 46% in the respective g roups. The ventilator time and the ICU time were longest in Group III, but again shorter for Group IV (with the highest mortality). The mean ventilator times were 2.7, 6.4, 8.4, and 5.9 days and the mean ICU ti mes were 4.1, 8.6, 10.3, and 7.3 days in the respective groups. Thirte en patients with SF > 100 nmol/L had a mean of 4.2 failing organ syste ms and an 85% mortality. Conclusion: Soluble fibrin, a marker of hyper coagulation, seems to predict organ system failure and outcome in ICU patients. (C) 1994 Wiley-Liss, Inc.