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The value of coagulation molecular markers TAT, PIC, TM and t-PAIC in early diagnosis of DIC

  • Department of Hematology,the Second Hospital of Anhui Medical University,Hefei 230601,China

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https://doi.org/10.3969/j.issn.0253-2778.2020.04.012
  • Received Date: 26 November 2019
  • Accepted Date: 20 April 2020
  • Rev Recd Date: 20 April 2020
  • Publish Date: 30 April 2020
    Abstract

  • Abstract

    Objective To explore the clinical significance of thrombin molecular marker in disseminated intrascular coagulation (DIC), which include thrombin-antithrombin complex (TAT), thrombomodulin (TM), plasmin-antiplasmin inhibitor complex (α2-plamininhibitor-plasmin complex,PIC) and tissue plasminogen activator inhibitor complex (t-PAIC) .Methods This study included 233 patients with bleeding tendency or thrombosis, according to the 2017 edition of the Chinese disseminated intravascular coagulation diagnostic score system (CDSS),who were divided into the dominant DIC group, pre-DIC group and non-DIC group. The differences in laboratory indicators between groups were compared, and its value in the early diagnosis of DIC was evaluated.The molecular markers were measured by qualitative chemiluminescence enzyme immunoassay performed on HISCL automated analyzers.All patients with suspected DIC were followed for 7 days to screen for development of overt-DIC.Results In patients with overt-DIC, TAT, TM, PIC were significantly higher than those in non-DIC patients, and t-PAIC was statistically insignificant between the overt-DIC and non-DIC groups. TAT, TM, PIC, t-PAIC levels were significantly higher in patients with pre-DIC than in non-DIC patients.The AUC shows that the combined diagnostic curve of TAT, TM, PIC, and t-PAIC is 0.887,and AUC combined PT, APTT, and D-D is 0.933.Conclusions The combination of TAT, TM, PIC and t-PAIC can improve the early diagnosis rate of DIC and provide optimal timing for early clinical intervention and treatment.

    Abstract

    Objective To explore the clinical significance of thrombin molecular marker in disseminated intrascular coagulation (DIC), which include thrombin-antithrombin complex (TAT), thrombomodulin (TM), plasmin-antiplasmin inhibitor complex (α2-plamininhibitor-plasmin complex,PIC) and tissue plasminogen activator inhibitor complex (t-PAIC) .Methods This study included 233 patients with bleeding tendency or thrombosis, according to the 2017 edition of the Chinese disseminated intravascular coagulation diagnostic score system (CDSS),who were divided into the dominant DIC group, pre-DIC group and non-DIC group. The differences in laboratory indicators between groups were compared, and its value in the early diagnosis of DIC was evaluated.The molecular markers were measured by qualitative chemiluminescence enzyme immunoassay performed on HISCL automated analyzers.All patients with suspected DIC were followed for 7 days to screen for development of overt-DIC.Results In patients with overt-DIC, TAT, TM, PIC were significantly higher than those in non-DIC patients, and t-PAIC was statistically insignificant between the overt-DIC and non-DIC groups. TAT, TM, PIC, t-PAIC levels were significantly higher in patients with pre-DIC than in non-DIC patients.The AUC shows that the combined diagnostic curve of TAT, TM, PIC, and t-PAIC is 0.887,and AUC combined PT, APTT, and D-D is 0.933.Conclusions The combination of TAT, TM, PIC and t-PAIC can improve the early diagnosis rate of DIC and provide optimal timing for early clinical intervention and treatment.
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    • References(19)
  • [1]
    中华医学会血液学分会血栓与止血学组.弥散性血管内凝血诊断中国专家共识(2017年版)[J].中华血液学杂志,2017,38(5):361-363.
    Thrombosis and Hemostasis Group, Hematology Society. Consensus of Chinese experts on diagnosis of disseminated intravascular coagulation (version 2017)[J]. Chinese Journal of Hematology, 2017,38(5):361-363.
    [2]
    彭作辉.弥散性血管内凝血前期诊断[J].中国实用内科杂志（临床版）,2000,20(6):338-342.
    [3]
    TAGAMI T, MATSUI H, HORIGUCHI H, et al. Recombinant human soluble thrombomodulin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation:An observational nationwide study[J].Journal of Thrombosis and Haemostasis: JTH, 2015,13(1): 31-40.
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    KURYLISYZN-MOSKAL A, ZARZYCKI W, DUBICKI A, et al. Clinical usefulness of videocapillaroscopy and selected endothelial cell activation markers in people with Type 1 diabetes mellitus complicated by microangiopathy[J].Adv Med Sci,2017,62(2): 368-373.
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    WADA H, MINAMIKAWA K, WAKITA Y, et al. Increased vascular endothelial cell markers in patients with disseminated intravascular coagulation[J]. Am J Hematol, 1993, 44(2): 85-88.
    [6]
    LIN S M, WANG Y M, LIN H C, et al. Serum thrombomodulin level relates to the clinical course of disseminated intravascular coagulation, multriorgan dysfunction syndrome,and mortality in patients with sepsis[J]. Crit Care Med, 2008, 36(3): 683-689.
    [7]
    ASAKURA H, JOKAJI H, SATIO M, et al. Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen antivator inhibitor in patients with disseminated intravascular coagulation[J]. Am J Hematol, 1991, 36(3): 176-183.
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    IKEDA M, KAN-NO H, HAYASHI M, et al. Predicting perioperative venous thromboboembolism in Japanese gynecological patients[J]. PLoS One,2014,9(2): e89206.
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    VERSTAAETE M, ZOLDHELYE P. Novel antithrombotic drugs in development[J]. Drugs,1995, 49(6): 856-884.
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    KOBAYASHI N, MAEKAWA T, TAKADA M, et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan[J]. Bibl Haematol, 1983(49): 265-275.
    [11]
    TAYLOR F J, TOH C H, HOOTS W K, et al. Towards definition, clinical andlaboratory criteria, and a scoring system for disseminated intravascular coagulation[J]. Thromb Haemost, 2001, 86(5): 1327-1330.
    [12]
    GANDO S, SAITOH D, OGURA H, et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: Results of a multicenter, prospective survey[J]. Crit Care Med, 2008, 36(1): 145-150.
    [13]
    WADA H, THACHIL J, DI NISIO M, et al.Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines[J]. J Thromb Haemost, 2013: DOI: 10.1111/jth.12155.
    [14]
    KINASEWITZ G T, ZEIN J G, LEE G L, et al. Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis[J]. Crit Care Med, 2005, 33: 2214-2221.
    [15]
    DHAINAUT J F, SHORR A F, MACIAS W L, et al. Dynamic evolution of coagulopathy in the first day of severe sepsis: Relationship with mortality and organ failure[J]. Crit Care Med, 2005, 33: 341-348.
    [16]
    EGI M, MORIMATSU H, WIEDERMANN C J, et al. Non-overt disseminated intravascular coagulation scoring for critically ill patients: The impact of antithrombin levels[J]. Thromb Haemost, 2009, 101: 696-705.
    [17]
    WADA H, HATADA T, OKAMOTO K, et al. Modified non-overt DIC diagnostic criteria predict the early phase of overt-DIC[J]. Am J Hematol, 2010, 85: 691-694.
    [18]
    WADA H, MATSUMOTO T, YAMASHITA Y. Disseminated intravascular coagulation: Testing and diagnosis[J]. Clin Chim Acta, 2014, 436: 130-134.
    [19]
    胡豫,王雅丹.英国DIC诊疗指南解读[J].国际输血及血液学杂志,2010,33(2):181-184.)
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    [1]
    中华医学会血液学分会血栓与止血学组.弥散性血管内凝血诊断中国专家共识(2017年版)[J].中华血液学杂志,2017,38(5):361-363.
    Thrombosis and Hemostasis Group, Hematology Society. Consensus of Chinese experts on diagnosis of disseminated intravascular coagulation (version 2017)[J]. Chinese Journal of Hematology, 2017,38(5):361-363.
    [2]
    彭作辉.弥散性血管内凝血前期诊断[J].中国实用内科杂志（临床版）,2000,20(6):338-342.
    [3]
    TAGAMI T, MATSUI H, HORIGUCHI H, et al. Recombinant human soluble thrombomodulin and mortality in severe pneumonia patients with sepsis-associated disseminated intravascular coagulation:An observational nationwide study[J].Journal of Thrombosis and Haemostasis: JTH, 2015,13(1): 31-40.
    [4]
    KURYLISYZN-MOSKAL A, ZARZYCKI W, DUBICKI A, et al. Clinical usefulness of videocapillaroscopy and selected endothelial cell activation markers in people with Type 1 diabetes mellitus complicated by microangiopathy[J].Adv Med Sci,2017,62(2): 368-373.
    [5]
    WADA H, MINAMIKAWA K, WAKITA Y, et al. Increased vascular endothelial cell markers in patients with disseminated intravascular coagulation[J]. Am J Hematol, 1993, 44(2): 85-88.
    [6]
    LIN S M, WANG Y M, LIN H C, et al. Serum thrombomodulin level relates to the clinical course of disseminated intravascular coagulation, multriorgan dysfunction syndrome,and mortality in patients with sepsis[J]. Crit Care Med, 2008, 36(3): 683-689.
    [7]
    ASAKURA H, JOKAJI H, SATIO M, et al. Changes in plasma levels of tissue-plasminogen activator/inhibitor complex and active plasminogen antivator inhibitor in patients with disseminated intravascular coagulation[J]. Am J Hematol, 1991, 36(3): 176-183.
    [8]
    IKEDA M, KAN-NO H, HAYASHI M, et al. Predicting perioperative venous thromboboembolism in Japanese gynecological patients[J]. PLoS One,2014,9(2): e89206.
    [9]
    VERSTAAETE M, ZOLDHELYE P. Novel antithrombotic drugs in development[J]. Drugs,1995, 49(6): 856-884.
    [10]
    KOBAYASHI N, MAEKAWA T, TAKADA M, et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan[J]. Bibl Haematol, 1983(49): 265-275.
    [11]
    TAYLOR F J, TOH C H, HOOTS W K, et al. Towards definition, clinical andlaboratory criteria, and a scoring system for disseminated intravascular coagulation[J]. Thromb Haemost, 2001, 86(5): 1327-1330.
    [12]
    GANDO S, SAITOH D, OGURA H, et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: Results of a multicenter, prospective survey[J]. Crit Care Med, 2008, 36(1): 145-150.
    [13]
    WADA H, THACHIL J, DI NISIO M, et al.Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines[J]. J Thromb Haemost, 2013: DOI: 10.1111/jth.12155.
    [14]
    KINASEWITZ G T, ZEIN J G, LEE G L, et al. Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis[J]. Crit Care Med, 2005, 33: 2214-2221.
    [15]
    DHAINAUT J F, SHORR A F, MACIAS W L, et al. Dynamic evolution of coagulopathy in the first day of severe sepsis: Relationship with mortality and organ failure[J]. Crit Care Med, 2005, 33: 341-348.
    [16]
    EGI M, MORIMATSU H, WIEDERMANN C J, et al. Non-overt disseminated intravascular coagulation scoring for critically ill patients: The impact of antithrombin levels[J]. Thromb Haemost, 2009, 101: 696-705.
    [17]
    WADA H, HATADA T, OKAMOTO K, et al. Modified non-overt DIC diagnostic criteria predict the early phase of overt-DIC[J]. Am J Hematol, 2010, 85: 691-694.
    [18]
    WADA H, MATSUMOTO T, YAMASHITA Y. Disseminated intravascular coagulation: Testing and diagnosis[J]. Clin Chim Acta, 2014, 436: 130-134.
    [19]
    胡豫,王雅丹.英国DIC诊疗指南解读[J].国际输血及血液学杂志,2010,33(2):181-184.)
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