Changes in indicators related to inflammatory cytokines, coagulation and fibrinolysis in patients with disseminated intravascular coagulation and multiple organ dysfunction syndrome caused by sepsis

Abstract

Objective To investigate changes in indicators related to inflammatory cytokines, coagulation and fibrinolysis system in patients with disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) resulted from sepsis. Methods In total, 97 patients diagnosed as sepsis were divided into different groups and their plasma concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), tissue factor (TF) and tissue factor pathway inhibitor (TFPI), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor 1 (PAI-1) were measured by ELISA and plasma activity of protein C (PC:A) was measured by chromogenic substrate assay. Results Plasma concentrations of TNF-α and I L-6 were (38 ± 12) ng/L and (77 ± 9) ng/L, respectively, in patients of sepsis complicated with DIC, much higher than those without DIC [ ( 17±6) ng/L and (45 ± 6), respectively], P <0.05;and (63±25) ng/L and (103±28) ng/L, respectively, in those complicated with MODS, significantly higher than in those without MODS [ (29 ± 7 ) ng/L and (48±9)ng/L, respectively], P < 0/05 and those without DIC [( 17 ± 6) ng/L and (45 ± 6) ng/L, respectively], P <0. 05;as well as significantly higher in the dead than in survivors (P <0. 05). Plasma activity of protein C was (32 ± 10) percent in those with DIC and (24 ± 12) percent in those with MODS, both significantly lower than in those without DIC [ (57±28) percent] and without MODS [ (55 ± 17) percent], respectively, P <0. 05, as well as significantly lower in the dead than in survivors, P <0. 05. Plasma concentrations of t-PA and PAI-1 were significantly higher in sepsis patients with DIC [(48±17)μg/L] than that in those without DIC [(103 ± 38)μg/L], P < 0.05. Conclusions Inflammatory cytokines play important roles in development of DIC as well as MODS in patients with sepsis. Decreased activity of protein C and increased plasma level of PAI-1 can result in deposition of fibrin on the vessel wall and thrombosis, which can be used as indicators of poor prognosis for patients with DIC. Key words: Systemic inflammatory response syndrome; Disseminated intravascular coagulation; Multiple organ failure