Endothelial cell activation and blood coagulation in critically ill patients with lung injury

Adult respiratory distress syndrome is a life-threatening disease that requires respiratory assistance. It is associated with endothelial cell damage, coagulation activation, and intravascular fibrin deposition. This prospective study was conducted to determine whether the plasma levels of specific markers of endothelial cell function and coagulation activation are related to the degree of pulmonary disturbance.

Fourteen patients (8 male, 6 female, median age 69 years), admitted to a medical intensive care unit with various stages of lung injury needing mechanical ventilation, were compared with 16 healthy age- and sex-matched control subjects.

Markers of endothelial cell damage and coagulation activation were significantly elevated in patients with lung injury compared with controls: von Willebrand factor (vWF) 4.12 vs. 1.25 U/ml, p < 0.0001; F VIII 4.40 vs. 1.88 U/ml, p = 0.0001; tissue-type plasminogen activator (tPA) 11.6 vs. 8.7 ng/ml, p = 0.02; plasminogen activator inhibitor-1 (PAI) 48.9 vs. 14.6 ng/ml, p < 0.0001; D-dimer 2.9 vs. 0.6 microgram/ml, p < 0.0001; thrombin-antithrombin III complex (TAT) 7.9 vs. 2.2 ng/ml, p < 0.0001 (median values; Mann-Whitney U-test). vWF, tPA, PAI and D-Dimer were significantly correlated with the PaO2/FiO2 ratio (p = 0.0003, 0.003, 0.04, 0.02, respectively; Spearman's rank correlation).

These findings suggest that the endothelial cell disturbance and the activation of the coagulation system in patients with lung injury are related to the degree of pulmonary dysfunction.