Is fibrinolysis a predictive marker of multiple organ failure in critically ill patients?

Background

C-reactive protein (CRP) is correlated with the risk of multiple organ failure (MOF) and death in intensive care patients [1]. CRP inhibits fibrinolysis by inducing plasminogen activator type 1 release by endothelial cells [2]. We observed a link between CRP and fibrinolysis at ICU admission [3].

Objective

We aimed to evaluate the relationship between CRP and fibrinolysis and the potential predictive value of fibrinolysis at admission in the ICU on the development of MOF.

Methods

Thirty-eight patients were enrolled. The plasma fibrinolytic capacity was assessed by the euglobulin clot lysis time (ECLT) determined by a semi-automatic method [4]. The ECLT, CRP and the SOFA score were measured on admission (time 1) and between the third and the fifth day (time 2) of the ICU stay.

Results

The ECLT was higher in septic than nonseptic patients (970 ± 928 min versus 503 ± 304 min [P = 0.042]). Platelet count remained stable between the two times. We found a correlation between ECLT on admission and SOFA score at time 2 (r = 0.67; P < 0.001). There was no link between ECLT and the mortality rate (P = 0.68). CRP was correlated with ECLT during the ICU stay (time 1: r = 0.74, P < 0.001; time 2: r = 0.60, P < 0.001).

Conclusion

The ECLT at admission could be a good predictive marker for the development of MOF between the third and the fifth day of the ICU stay.

A correlation exists between CRP and the ECLT during all the ICU stay. This finding is compatible with a link between inflammation and fibrinolysis and may explain the negative prognostic value of high concentrations of CRP in critically ill patients.