The relation between fibrinogen level, neutrophil activity and nucleosomes in the onset of disseminated intravascular coagulation in the critically ill. (9th July 2021)

• Record Type: Journal Article
• Authors: Müller, Marcella C.A.; Dujardin, Romein W.G.; Thachil, Jecko; van Mierlo, Gerard; Zeerleder, Sacha S.; Juffermans, Nicole P.
• Is Part Of: Journal of internal medicine. Volume 290:Number 4(2021)
• Page Start: 922
• Page End: 927
• Publication Date: 2021-07-09
• Subjects: disseminated intravascular coagulation -- fibrinogen -- nucleosomes -- organ failure -- thrombocytopenia; Internal medicine -- Periodicals; Medicine -- Periodicals; 616
• DOI: 10.1111/joim.13346
• Languages: English
• ISSNs: 0954-6820

Abstract

Abstract: Background: Nucleosomes and neutrophil extracellular traps (NETs) are important in the pathophysiology of disseminated intravascular coagulation (DIC). Fibrinogen, as an acute phase reactant, may be protective by engaging neutrophils. We hypothesize that DIC can occur when NET formation becomes uncontrolled in relation to low fibrinogen levels. Patients/method: The ratio of both circulating nucleosomes and human neutrophil elastase alpha‐1‐antitrypsine complexes (HNE‐a1ATc) to fibrinogen was correlated to thrombocytopenia, DIC and organ failure in 64 critically ill coagulopathic patients. Results: A high nucleosome to fibrinogen ratio correlated with thrombocytopenia and organ failure ( ρ −0.391, p 0.01 and ρ 0.556, p 0.01, respectively). A high HNE‐a1ATc to fibrinogen ratio correlated with thrombocytopenia, DIC and organ failure ( ρ −0.418, p 0.01, ρ 0.391, p 0.01 and ρ 0.477, p 0.01 respectively). Conclusion: These findings support the hypothesis that fibrinogen is protective against DIC by counterbalancing excessive neutrophil activation.