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Role of endothelin in disseminated intravascular coagulation
1Department of Internal Medicine (III), Kanazawa University School of Medicine, Japan.
Insights
Elevated endothelin-1 (ET-1) levels are linked to disseminated intravascular coagulation (DIC) and multiple organ failure (MOF). Higher ET-1 indicates poorer prognosis in DIC patients, suggesting its role in MOF progression.
Area of Science:
- Cardiovascular Physiology
- Hematology
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome with high mortality.
- Multiple organ failure (MOF) is a common and severe complication of DIC.
- Endothelin-1 (ET-1) is a potent vasoconstrictor with potential roles in circulatory disorders.
Purpose of the Study:
- To investigate the role of plasma endothelin-1 (ET-1) levels in disseminated intravascular coagulation (DIC).
- To determine the relationship between ET-1 levels and the development of multiple organ failure (MOF) in DIC patients.
- To assess the prognostic value of ET-1 levels in DIC.
Main Methods:
- Plasma levels of endothelin-1 (ET-1) were measured in 47 patients with DIC.
- ET-1 levels were correlated with clinical conditions, including underlying causes of DIC and presence of MOF.
- Changes in ET-1 levels were monitored in relation to clinical improvement or deterioration.
Main Results:
- Significant elevation of plasma ET-1 was observed in DIC patients with sepsis, blastic crisis of chronic myelogenous leukemia, and cancer.
- No significant ET-1 elevation was noted in patients with acute promyelocytic leukemia (APL), other acute leukemias, or non-Hodgkin lymphoma.
- Higher ET-1 levels were associated with the presence of MOF in DIC patients.
- Decreasing ET-1 levels correlated with clinical improvement, while persistently high levels indicated poor prognosis.
Conclusions:
- Endothelin-1 (ET-1) plays a significant role in the pathophysiology of disseminated intravascular coagulation (DIC).
- Elevated ET-1 levels are associated with specific etiologies of DIC and the development of multiple organ failure (MOF).
- ET-1 may contribute to the progression of MOF through vasoconstriction and microcirculatory disturbances.
Abstract:
We examined the changes in plasma levels of endothelin-1 (ET-1), a potent vasoconstrictor peptide, in 47 cases of disseminated intravascular coagulation (DIC) to investigate the role of ET-1 in DIC and its relation to multiple organ failure (MOF). A significant elevation of plasma levels of ET-1 was observed in some cases of DIC, especially in patients with sepsis, blastic crisis of chronic myelogenous leukemia, and cancer. However, no such significant elevation was observed in patients with acute promyelocytic leukemia (APL), acute leukemias except for APL, or non-Hodgkin lymphoma. Plasma levels of ET-1 were higher in patients with DIC with MOF than in those without MOF. Although the levels of ET-1 were decreased or remained low with clinical improvement in most DIC patients, the levels were further increased or remained high in patients who showed no improvement in DIC. It is suggested that ET-1 must play an important role in further progression of MOF with the vasoconstriction and microcirculatory disorders.