Plasma levels of granulocyte-derived elastase (GE-XDP), D-dimer, and soluble fibrin (SF) were examined in 177 patients with disseminated intravascular coagulation (DIC) of various etiologies. Plasma levels of GE-XDP and D-dimer, but not SF, were significantly high in patients with sepsis and solid cancer. The ratio of GE-XDP/D-dimer was significantly high in patients with trauma, burn, and sepsis, suggesting that fibrinolysis due to GE-XDP may be dominant in DIC. Plasma levels of GE-XDP and D-dimer, but not SF, were significantly high in patients with overt DIC and correlated with DIC score. Plasma levels of GE-XDP, but not SF, correlated significantly with D-dimer. Plasma levels of D-dimer, but not SF, correlated significantly with plasmin plasmin inhibitor complex (PPIC). Plasma levels of GEXDP and D-dimer, but not SF, were significantly high in nonsurvivors. Plasma levels of GE-XDP, but not SF, correlated significantly with sepsis-related organ failure assessment (SOFA) score. These results suggest that GE-XDP is a potentially useful marker for the diagnosis of overt-DIC and as a predictor of organ failure-related outcome.
Ohlsson K, Olsson I.The extracellular release of granulocyte collagenase and elastase during phagocytosis and inflammatory processes. Scand J Haemotol1977;19:145.
2.
Janoff A.Elastase in tissue injury. Annu Rev Med1985;36:207.
3.
Neumann S, Hennrich N, Gunzer G, Lang H.Enzyme-linked immunoassay for elastase from leukocyte in human granulocyte elastase in complex with alpha-1 proteinase inhibitor. Adv Exp Med Biol1984;167:379.
4.
Weitz JI, Huang AJ, Landman SL, et al.Elastase-mediated fibrinogenolysis by chemoattractant-stimulated neutrophils occurs in the presence of physiologic concentrations of antiproteinases. J Exp Med1987;166:1836.
5.
Matheson NR, Wong PS, Travis J.Enzymatic inactivation of human alpha-1-proteinase inhibitor by neutrophil myeloperoxidase. Biochem Biophys Res Commun1979;88:402.
6.
Weiss SJ, Curmutte JT, Regiani S.Neutrophil-mediated solubilization of the subendothelial matrix: Oxidative and non-oxidative mechanism of proteolysis used by normal and chronic granulomatous disease phagocytes. J Immunol1986;136:636.
7.
Levi M, de Jonge E, van der Poll T, ten Cate H.Disseminated intravascular coagulation. Thromb Haemost1999;82:695.
8.
Müller-Berghaus G, ten Cate H, Levi M.Disseminated intravascular coagulation: Clinical spectrum and established as well as new diagnostic approaches. Thromb Haemost1999;82:706.
9.
Bos R, van Leuven CJM, Stolk J, et al.A monoclonal antibody with high affinity for a neo-antigenic site in fibrinogen degraded by polymorphonuclear leukocyte-derived elastase. Blood Coagul Fibrinolysis1995;6:259.
10.
Plow EF, Gramse M, Havemann K.Immunochemical discrimination of leukocyte elastase from plasmic degradation products of fibrinogen. J Lab Clin Med1983;102:858.
11.
Kobayashi N, Maegawa K, Takada M, et al.Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibl Haemotol1987;49:265.
12.
Bernard GR, Vincent JL, Laterre PF, et al.Efficacy and safety of recombinant human protein C for severe sepsis. N Engl J Med2001;8:699.
13.
Waydhas C, Nast-Kolb D, Gippner-Steppert C, et al.High-dose antithrombin III treatment of severely injured patients: Results of a prospective study. J Trauma1998;45:931.
14.
Maruyama I.Recombinant thrombomodulin and activated protein C in the treatment of disseminated intravascular coagulation. Thromb Haemost1999;82:718.
15.
Abraham E.Tissue factor inhibition and clinical trial results of tissue factor pathway inhibitor in sepsis. Crit Care Med2000;28(Suppl):s31.
16.
Taylor FB Jr, Toh CH, Hoots WK, et al.Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost2001;86:1327.
17.
Vincent JL, Moreno R, Takara J.The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med1996;22:707.
18.
Ohno H, Kambayashi J, Changs SW, Kosaki G.FOY;[ethyl p-(6-guanidino-hexanoxyloxy) benzoate] methanesulfonate as a serine protease inhibitor: II. In vivo effect on coagulofibrinolytic system in comparison with heparin or aprotinin. Thromb Res1980;24:452.
19.
Kohno I, Inuzuka K, Itoh Y, et al.A monoclonal antibody specific to the granulocyte-derived elastase-fragment D species of human fibrinogen and fibrin: Its application to the measurement of granulocyte-derived elastase digests in plasma. Blood2000;95:1721.
20.
Matsuda M, Terukina S, Yamazumi K, et al.A monoclonal antibody that recognizes the NH2-terminal conformation of fragment D. In: Matsuda M, Iwanaga S, Takada A, Henschen A, eds. Fibrinogen 4, Current Basic and Clinical Aspects. Excerpta Medica, Amsterdam; 1990:43.
21.
Soe G, Kohno I, Inuzuka K, et al.A monoclonal antibody that recognizes a neo-antigen exposed in the E domain of fibrin monomer complexed with fibrinogen or its derivatives: Its application to the measurement of soluble fibrin in plasma. Blood1996;88:2109.
22.
Quick AJ, Brown MS, Bancroft FW. A study of the coagulation defect in hemophilia and in jaundice. Am J Med Sci1935;190:501.
23.
Wada H, Wakita Y, Nakase T, et al.Increased plasma-soluble fibrin monomer levels in patients with disseminated intravascular coagulation. Am J Hematol1996;51:255.
24.
Takahashi H, Tatewaki W, Wada K, et al.Thrombin vs plasmin generation in disseminated intravascular coagulation associated with various underlying disorders. Am J Hematol1990;33:90.
25.
Wada H, Sakuragawa N, Shiku H.Hemostatic molecular markers before onset of disseminated intravascular coagulation in leukemic patients. Semin Thromb Hemost1998;24:294.
26.
Wada H, Mori Y, Shimura M, et al.Poor outcome in disseminated intravascular coagulation or thrombotic thrombocytopenic purpura patients with severe vascular endothelial cell injuries. Am J Hematol1998;58:189.
