Hypofibrinogenemia is associated with a high degree of risk in infectious diseases: a post-hoc analysis of post-marketing surveillance of patients with disseminated intravascular coagulation treated with thrombomodulin alfa

Thrombosis Journal

Seiji Madoiwa¹  Toshiaki Iba²  Hideo Wada³  Takayuki Ikezoe⁴  Naoki Takezako⁵  Yoshinobu Seki⁶  Noriaki Kawano⁷  Toshimasa Uchiyama⁸  Goichi Honda⁹  Kohji Okamoto^1,10  Kei Suzuki^1,11  Kazuo Kawasugi^1,12 

[1] Department of Clinical Laboratory Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan;Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan;Department of General Medicine, Mie Prefectural General Medical Center, Yokkaichi, Japan;Department of Hematology, Fukushima Medical University, Fukushima, Japan;Department of Hematology, National Hospital Organization Disaster Medical Center, Tokyo, Japan;Department of Hematology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan;Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan;Department of Laboratory Medicine, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan;Department of Medical Affairs, Asahi Kasei Pharma Corporation, Tokyo, Japan;Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan;Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan;Faculty of Medical Technology, Teikyo University, Tokyo, Japan;

关键词: Disseminated intravascular coagulation;    Hypofibrinogenemia;    Thrombomodulin;    Post-marketing surveillance;    Infectious disease;    Mortality;   

DOI  :  10.1186/s12959-021-00264-z

来源: Springer

【 摘 要 】

BackgroundIn 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.MethodsWe 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.ResultsHypofibrinogenemia 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.ConclusionsHypofibrinogenemia 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.

【 授权许可】

CC BY