Kazuo Kawasugi1, Hideo Wada2, Goichi Honda3, Noriaki Kawano4, Toshimasa Uchiyama5, Seiji Madoiwa6, Naoki Takezako7, Kei Suzuki8, Yoshinobu Seki9, Takayuki Ikezoe10, Toshiaki Iba11, Kohji Okamoto12. 1. Faculty of Medical Technology, Teikyo University, Tokyo, Japan. 2. Department of General Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan. wadahide@clin.medic.mie-u.ac.jp. 3. Department of Medical Affairs, Asahi Kasei Pharma Corporation, Tokyo, Japan. 4. Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan. 5. Department of Laboratory Medicine, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan. 6. Department of Clinical Laboratory Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan. 7. Department of Hematology, National Hospital Organization Disaster Medical Center, Tokyo, Japan. 8. Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan. 9. Department of Hematology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan. 10. Department of Hematology, Fukushima Medical University, Fukushima, Japan. 11. Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 12. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan.
Abstract
BACKGROUND: In patients with infectious diseases, disseminated intravascular coagulation (DIC) is often diagnosed without the fibrinogen value. The relationship between hypofibrinogenemia and outcomes of DIC in infectious diseases has thus remained unclear. METHODS: We analyzed 3204 patients who received with thrombomodulin alfa (TM-α) for DIC and suspected DIC. Hypofibrinogenemia was defined by a fibrinogen level < 1.5 g/L. RESULTS: Hypofibrinogenemia was observed in 10.3% of patients with infectious diseases. The frequencies of both bleeding and organ failure symptoms, and the scores for organ failure or the DIC diagnostic criteria were significantly higher in infectious disease patients with hypofibrinogenemia, suggesting that in patients with infectious diseases, hypofibrinogenemia is associated with more progressive and severe DIC. Although the 28-day survival rate and the DIC resolution rate were both significantly lower for infectious disease patients with DIC with hypofibrinogenemia than for those without hypofibrinogenemia, this difference was not observed in DIC patients with hematological diseases. CONCLUSIONS: Hypofibrinogenemia among infectious disease patients with DIC may reflect increased consumption of fibrinogen due to accelerated coagulation reactions, while hypofibrinogenemia among hematological disease patients with DIC may be caused by fibrinogenolysis due to hyperfibrinolysis, and frequently results in bleeding and multiple-organ failure.
BACKGROUND: In patients with infectious diseases, disseminated intravascular coagulation (DIC) is often diagnosed without the fibrinogen value. The relationship between hypofibrinogenemia and outcomes of DIC in infectious diseases has thus remained unclear. METHODS: We analyzed 3204 patients who received with thrombomodulin alfa (TM-α) for DIC and suspected DIC. Hypofibrinogenemia was defined by a fibrinogen level < 1.5 g/L. RESULTS:Hypofibrinogenemia was observed in 10.3% of patients with infectious diseases. The frequencies of both bleeding and organ failure symptoms, and the scores for organ failure or the DIC diagnostic criteria were significantly higher in infectious diseasepatients with hypofibrinogenemia, suggesting that in patients with infectious diseases, hypofibrinogenemia is associated with more progressive and severe DIC. Although the 28-day survival rate and the DIC resolution rate were both significantly lower for infectious diseasepatients with DIC with hypofibrinogenemia than for those without hypofibrinogenemia, this difference was not observed in DICpatients with hematological diseases. CONCLUSIONS:Hypofibrinogenemia among infectious diseasepatients with DIC may reflect increased consumption of fibrinogen due to accelerated coagulation reactions, while hypofibrinogenemia among hematological diseasepatients with DIC may be caused by fibrinogenolysis due to hyperfibrinolysis, and frequently results in bleeding and multiple-organ failure.