Contrasting post-traumatic serial changes for D-dimer and PAI-1 in critically injured patients

被引:32
作者
Chen, JP
Rowe, DW
Enderson, BL
机构
[1] Univ Tennessee, Med Ctr, Dept Med Biol, Grad Sch Med, Knoxville, TN 37920 USA
[2] Univ Tennessee, Med Ctr, Dept Surg, Grad Sch Med, Knoxville, TN 37920 USA
关键词
trauma patients; fibrin D-dimer; plasminogen activator inhibitor-1; pathologic thrombosis;
D O I
10.1016/S0049-3848(98)00211-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We measured D-dimer and plasminogen activator inhibitor-1 (PAI-1) activity in 45 trauma patients to assess their efficacy in predicting the post-traumatic hemostatic perturbations. We found the correlation between D-dimer measured by Simpli Red test and ELISA to be highly significant (p = 0.0001). The D-dimer ELISA indicated that the serial changes of D-dimer after trauma were variable. However, the increases of D-dimer were associated with clinical conditions of the patient, such as trauma surgery, infections, or thrombotic complications. A significant correlation was found for D-dimer levels measured by ELISA versus the injury severity score (ISS) in all the trauma patients on day 1 (p = 0.0153) and on day 2 (p = 0.0495). The PAI-1 activity was increased at admission and showed a progessive decline from day 2 onward, and the correlation for the daily decline of PAI-1 was highly significant (p = 0.0001). The PAI-1 activity and plasminogen activator activity showed a significant negative correlation on days 1, 2, and 3. PAI-1 activity correlated moderately with D-dimer level only on day 1 (p = 0.0569). Three out of forty-five patients developed thrombotic complications: one patient who died fr om pulmonary embolism and two patients who developed adult respiratory distress syndrome (ARDS). In summary: 1) PAI-1 activity and D-dimer exhibited contrasting serial changes after trauma. 2) There was also a negative correlation between PAI-1 activity and PA activity. 3) A significant correlation of D-dimer with ISS confirms, as might be anticipated, that there is increased activation of the coagulation mechanism in severe injury, and suggests that D-dimer levels map prove useful to screen for patients at strong risks of thrombotic complications. (C) 1999 Elsevier Science Ltd. All rights reserved.
引用
收藏
页码:175 / 185
页数:11
相关论文
共 25 条
[1]  
[Anonymous], 1988, J Intensive Care Med, DOI DOI 10.1177/088506668800300205
[2]   INJURY SEVERITY SCORE - METHOD FOR DESCRIBING PATIENTS WITH MULTIPLE INJURIES AND EVALUATING EMERGENCY CARE [J].
BAKER, SP ;
ONEILL, B ;
HADDON, W ;
LONG, WB .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1974, 14 (03) :187-196
[3]   DEPRESSED BRONCHOALVEOLAR UROKINASE ACTIVITY IN PATIENTS WITH ADULT RESPIRATORY-DISTRESS SYNDROME [J].
BERTOZZI, P ;
ASTEDT, B ;
ZENZIUS, L ;
LYNCH, K ;
LEMAIRE, F ;
ZAPOL, W ;
CHAPMAN, HA .
NEW ENGLAND JOURNAL OF MEDICINE, 1990, 322 (13) :890-897
[4]   THROMBIN-INDUCED CHEMOTAXIS AND AGGREGATION OF NEUTROPHILS [J].
BIZIOS, R ;
LAI, L ;
FENTON, JW ;
MALIK, AB .
JOURNAL OF CELLULAR PHYSIOLOGY, 1986, 128 (03) :485-490
[5]  
CHAN KL, 1988, CELL, V20, P13
[6]  
CHEN JP, 1995, FASEB J, V9, pA838
[7]   FIBRINOLYSIS IN MULTISYSTEM TRAUMA PATIENTS [J].
ENDERSON, BL ;
CHEN, JP ;
ROBINSON, R ;
MAULL, KI .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1991, 31 (09) :1240-1246
[8]  
Flute P T, 1970, J Clin Pathol Suppl (R Coll Pathol), V4, P102
[9]   A PROSPECTIVE-STUDY OF VENOUS THROMBOEMBOLISM AFTER MAJOR TRAUMA [J].
GEERTS, WH ;
CODE, KI ;
JAY, RM ;
CHEN, EL ;
SZALAI, JP .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (24) :1601-1606
[10]   THE DETECTION OF D-DIMER IN PLASMA BY ENZYME-IMMUNOASSAY - IMPROVED DISCRIMINATION IS OBTAINED WITH A MORE SPECIFIC SIGNAL ANTIBODY [J].
HART, R ;
BATE, I ;
DINH, D ;
ELMS, M ;
BUNDESEN, P ;
HILLYARD, C ;
RYLATT, DB .
BLOOD COAGULATION & FIBRINOLYSIS, 1994, 5 (02) :227-232