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Role of DIC in multiple organ failure
1Department of Surgery, Juntendo University, Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba 279-0021, Japan.
International Journal of Surgical Investigation
|May 31, 2003
Summary
Septic disseminated intravascular coagulation (DIC) involves endothelial damage leading to fibrinolysis-suppressive DIC. Diagnosis relies on platelet count and fibrin degradation products, with treatment targeting vascular damage and coagulopathy.
Area of Science:
- Hematology
- Pathophysiology
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a severe coagulopathy characterized by excessive thrombin generation.
- While sharing common pathways like consumption coagulopathy and multiple organ failure (MOF), the early pathophysiology of DIC varies with the underlying disease.
Purpose of the Study:
- To elucidate the pathophysiology of septic DIC.
- To assess logical diagnostic and therapeutic procedures for septic DIC.
Main Methods:
- Analysis of coagulant, fibrinolytic, and vascular markers.
- Blood samples were collected from patients with sepsis.
Main Results:
- Damaged vascular endothelial cells overproduce plasminogen activator inhibitor 1 (PAI-1).
- Excess thrombin production combined with PAI-1 leads to fibrinolysis-suppressive DIC and microvascular fibrin formation.
- Septic coagulopathy is often complicated by MOF, with a relatively rare bleeding tendency.
Conclusions:
- Platelet count and fibrinogen/fibrin degradation products are key diagnostic markers for septic DIC.
- Additional tests, including molecular markers, are needed due to insufficient specificity of screening tests.
- Treatment should address both coagulopathy and vascular damage, with protease inhibitors and antithrombin III being effective; heparin is not recommended for septic DIC.