Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study
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 di...
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doaj-0011f67a58974ec1b2e4fe1a8d407b342020-11-25T00:11:25ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2016-11-01310.3389/fmed.2016.00064220753Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot StudyAgnese Ozolina0Agnese Ozolina1Marina Sarkele2Marina Sarkele3Olegs Sabelnikovs4Olegs Sabelnikovs5Andrejs Skesters6Inta Jaunalksne7Jelena Serova8Talis Ievins9Lars Jakob Bjertnæs10Indulis Vanags11Indulis Vanags12Riga Stradins UniversityPauls Stradins Clinical University HospitalRiga Stradins UniversityPauls Stradins Clinical University HospitalRiga Stradins UniversityPauls Stradins Clinical University HospitalRiga Stradins UniversityPauls Stradins Clinical University HospitalPauls Stradins Clinical University HospitalRiga Stradins UniversityUniversity of TromsøRiga Stradins UniversityPauls Stradins Clinical University HospitalIntroduction: 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: patients with PaO2/FiO2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 hours, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria: 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 (T0) and on third (T3) and seventh day (T7) of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic (ROC) curve analysis. Statistical significance: p < 0.05.Results: Of 24 patients at risk, six developed mild ARDS and four 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 PaO2/FiO2 and PEEP 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.Conclusions: This pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after seven days in ICU.http://journal.frontiersin.org/Journal/10.3389/fmed.2016.00064/fullLung InjuryTissue Plasminogen ActivatorPlasminogen activator inhibitor-1tissue factorAcute Respiratory Distress Syndromeventilator-associated lung injury |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Agnese Ozolina Agnese Ozolina Marina Sarkele Marina Sarkele Olegs Sabelnikovs Olegs Sabelnikovs Andrejs Skesters Inta Jaunalksne Jelena Serova Talis Ievins Lars Jakob Bjertnæs Indulis Vanags Indulis Vanags |
spellingShingle |
Agnese Ozolina Agnese Ozolina Marina Sarkele Marina Sarkele Olegs Sabelnikovs Olegs Sabelnikovs Andrejs Skesters Inta Jaunalksne Jelena Serova Talis Ievins Lars Jakob Bjertnæs Indulis Vanags Indulis Vanags Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study Frontiers in Medicine Lung Injury Tissue Plasminogen Activator Plasminogen activator inhibitor-1 tissue factor Acute Respiratory Distress Syndrome ventilator-associated lung injury |
author_facet |
Agnese Ozolina Agnese Ozolina Marina Sarkele Marina Sarkele Olegs Sabelnikovs Olegs Sabelnikovs Andrejs Skesters Inta Jaunalksne Jelena Serova Talis Ievins Lars Jakob Bjertnæs Indulis Vanags Indulis Vanags |
author_sort |
Agnese Ozolina |
title |
Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study |
title_short |
Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study |
title_full |
Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study |
title_fullStr |
Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study |
title_full_unstemmed |
Activation of Coagulation and Fibrinolysis in Acute Respiratory Distress Syndrome: a Prospective Pilot Study |
title_sort |
activation of coagulation and fibrinolysis in acute respiratory distress syndrome: a prospective pilot study |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2016-11-01 |
description |
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: patients with PaO2/FiO2 < 300 mmHg admitted to the intensive care unit (ICU) for mechanical ventilation for 24 hours, or more, because of one or more disease conditions associated with increased risk of developing ARDS. Exclusion criteria: 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 (T0) and on third (T3) and seventh day (T7) of the ICU stay with non-parametric statistics inclusive their sensitivity and specificity associated with the development of ARDS using receiver operating characteristic (ROC) curve analysis. Statistical significance: p < 0.05.Results: Of 24 patients at risk, six developed mild ARDS and four 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 PaO2/FiO2 and PEEP 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.Conclusions: This pilot study showed that increased plasma concentrations of TF and PAI-1 might support ARDS diagnoses in mechanically ventilated patients after seven days in ICU. |
topic |
Lung Injury Tissue Plasminogen Activator Plasminogen activator inhibitor-1 tissue factor Acute Respiratory Distress Syndrome ventilator-associated lung injury |
url |
http://journal.frontiersin.org/Journal/10.3389/fmed.2016.00064/full |
work_keys_str_mv |
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