Marked reductions of protein C and antithrombin in post-trauma DIC have close relations with MODS and poor outcome

Objective

Disseminated intravascular coagulation (DIC) associated with marked reductions of protein C and antithrombin in post-trauma patients have close relations with multiple organ dysfunction syndrome (MODS) and their outcome.

Design

Prospective cohort study.

Setting

General intensive care unit of a tertiary care emergency department.

Patients

Seventy-six trauma victims, 26 with DIC and 50 without DIC.

Materials and methods

Protein C antigen concentration (protein C antigen), protein C activity, and antithrombin were measured on the day of the injury, and on the 1 st, 3 rd, and 5 th days after admission. The results of these measurements, demographic data, mortality and incidence of acute respiratory distress syndrome (ARDS), MODS, and sepsis were compared between the patients with and without DIC. DIC patients were further classified into subgroups of survivors and nonsurvivors.

Results

Incidence of ARDS and MODS were significantly high in the DIC patients. The mortality rate of the DIC patients was significantly higher than that of the non-DIC patients. Protein C antigen and activity, and antithrombin decreased significantly in the DIC patients compared with those in the non-DIC patients, which continued to be low up to the 5 th day of admission. Clear intergroup differences of the time course were also noted in the levels of protein C antigen and activity, and antithrombin between the survivors and nonsurvivors in the DIC group.

Conclusion

Our findings suggest that DIC involving suppression of the physiologic anticoagulant pathways is an important contributor of MODS and poor outcome in post-trauma patients.