TY - JOUR
T1 - Activation of coagulation and fibrinolysis in acute respiratory distress syndrome
T2 - A prospective pilot study
AU - Ozolina, Agnese
AU - Sarkele, Marina
AU - Sabelnikovs, Olegs
AU - Skesters, Andrejs
AU - Jaunalksne, Inta
AU - Serova, Jelena
AU - Ievins, Talis
AU - Bjertnaes, Lars J.
AU - Vanags, Indulis
N1 - Funding Information:
The study was supported by grant ZP 10/2013 from Rigas Stradins University.
Publisher Copyright:
© 2016 Ozolina, Sarkele, Sabelnikovs, Skesters, Jaunalksne, Serova, Ievins, Bjertnaes and Vanags.
PY - 2016
Y1 - 2016
N2 - Introduction: Coagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS). We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) in mechanically ventilated patients at increased risk of developing ARDS. Materials and methods: We performed an ethically approved prospective observational pilot study. Inclusion criteria were patients with PaO 2 /FiO 2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 h, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria were age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA, and PAI-1 at inclusion (tissue) and on third (T 3 ) and seventh day (T 7 ) of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic curve analysis. Statistical significance: p < 0.05. Results: Of 24 patients at risk, 6 developed mild ARDS and 4 of each moderate or severe ARDS, respectively, 3 ± 2 (mean ± SD) days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO 2 /FiO 2 , and positive end-expiratory pressure and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0.78, p = 0.02. PAI-1 displayed 64% sensitivity and 100% specificity with a cut off concentration of 117.5 pg/ml and AUC 0.77, p = 0.02. t-PA did not change significantly during the observation time. Conclusion: This pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after 7 days in ICU.
AB - Introduction: Coagulation and fibrinolysis remain sparsely addressed with regards to acute respiratory distress syndrome (ARDS). We hypothesized that ARDS development might be associated with changes in plasma coagulation and fibrinolysis. Our aim was to investigate the relationships between ARDS diagnosis and plasma concentrations of tissue factor (TF), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) in mechanically ventilated patients at increased risk of developing ARDS. Materials and methods: We performed an ethically approved prospective observational pilot study. Inclusion criteria were patients with PaO 2 /FiO 2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 h, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria were age below 18 years; cardiac disease. We sampled plasma prospectively and compared patients who developed ARDS with those who did not using descriptive statistics and chi-square analysis of baseline demographical and clinical data. We also analyzed plasma concentrations of TF, t-PA, and PAI-1 at inclusion (tissue) and on third (T 3 ) and seventh day (T 7 ) of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic curve analysis. Statistical significance: p < 0.05. Results: Of 24 patients at risk, 6 developed mild ARDS and 4 of each moderate or severe ARDS, respectively, 3 ± 2 (mean ± SD) days after inclusion. Median plasma concentrations of TF and PAI-1 were significantly higher at T7 in patients with ARDS, as compared to non-ARDS. Simultaneously, we found moderate correlations between plasma concentrations of TF and PAI-1, TF and PaO 2 /FiO 2 , and positive end-expiratory pressure and TF. TF plasma concentration was associated with ARDS with 71% sensitivity and 100% specificity, a cut off level of 145 pg/ml and AUC 0.78, p = 0.02. PAI-1 displayed 64% sensitivity and 100% specificity with a cut off concentration of 117.5 pg/ml and AUC 0.77, p = 0.02. t-PA did not change significantly during the observation time. Conclusion: This pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after 7 days in ICU.
KW - Acute respiratory distress syndrome
KW - Lung injury
KW - Plasminogen activator inhibitor-1
KW - Tissue factor
KW - Tissue plasminogen activator
KW - Ventilator-associated lung injury
UR - http://www.scopus.com/inward/record.url?scp=85029538900&partnerID=8YFLogxK
U2 - 10.3389/fmed.2016.00064
DO - 10.3389/fmed.2016.00064
M3 - Article
AN - SCOPUS:85029538900
VL - 3
JO - Frontiers in Medicine
JF - Frontiers in Medicine
IS - NOV
M1 - 64
ER -