The relation between fibrinogen level, neutrophil activity and nucleosomes in the onset of disseminated intravascular coagulation in the critically ill.

Abstract

BACKGROUND:

Nucleosomes and neutrophil extracellular traps (NETs) are important in the pathophysiology of disseminated intravascular coagulation (DIC). Fibrinogen, as an acute phase reactant, may be protective by engaging neutrophils. We hypothesize that DIC can occur when NET formation becomes uncontrolled in relation to low fibrinogen levels.

PATIENTS/METHOD:

The ratio of both circulating nucleosomes and human neutrophil elastase alpha-1-antitrypsine complexes (HNE-a1ATc) to fibrinogen was correlated to thrombocytopenia, DIC and organ failure in 64 critically ill coagulopathic patients.

RESULTS:

A high nucleosome to fibrinogen ratio correlated with thrombocytopenia and organ failure (ρ -0.391, p 0.01 and ρ 0.556, p 0.01, respectively). A high HNE-a1ATc to fibrinogen ratio correlated with thrombocytopenia, DIC and organ failure (ρ -0.418, p 0.01, ρ 0.391, p 0.01 and ρ 0.477, p 0.01 respectively).

CONCLUSION:

These findings support the hypothesis that fibrinogen is protective against DIC by counterbalancing excessive neutrophil activation.

• Authors: Marcella C A Müller, Romein W G Dujardin, Jecko Thachil, Gerard van Mierlo, Sacha S Zeerleder, Nicole P Juffermans
• Journal: Journal of internal medicine (J Intern Med) Vol. 290 Issue 4 Pg. 922-927 (10 2021) ISSN: 1365-2796 [Electronic] England
• PMID: 34137469 (Publication Type: Journal Article)
• Copyright: © 2021 The Association for the Publication of the Journal of Internal Medicine.

Chemical References

• Nucleosomes
• Fibrinogen

Topics

• Critical Illness
• Disseminated Intravascular Coagulation (diagnosis)
• Fibrinogen (analysis)
• Humans
• Neutrophils (cytology)
• Nucleosomes
• Thrombocytopenia