Neutrophil elastase may play a key role in developing symptomatic disseminated intravascular coagulation and multiple organ failure in patients with head injury

Objective: To study the mechanism associated with the development of symptomatic disseminated intravascular coagulation (DIC) after head injury. Methods: Plasma parameters were analyzed in patients with symptomatic (group A, n = 10) and asymptomatic DIC (group B, n = 15) induced by head injury, and in patients in whom DIC was caused by sepsis (group C, n = 10), Results: Levels of fibrinogen, alpha 2PI-plasmin complex and platelets in group A (58.1 mg/dL, 22.4 mu g/mL, 16.0 x 10(4)/mm(3)) and group 11 (98.3, 22.1, 16.6 x 10(4)) were comparable, but differed significantly from those in group C (297.4, 2.4, 6.3 x 10(4)). Significant differences were observed between groups A and B in both neutrophil-elastase (1,528 vs. 293 mu g/ml) and D-dimer (42.1 vs. 17.6 mu g/mL). Conclusion: Neutrophil elastase may he implicated in the development of symptomatic DIC after head injury, whose characteristics include "enhanced fibrinolysis with minimal platelet loss."