Correlation between plasma activity of ADAMTS-13 and coagulopathy, and prognosis in disseminated intravascular coagulation

Introduction: In disseminated intravascular coagulation (DIC), widespread activation of intravascular coagulation accompanied with florid endothelial activation results in release of unusually large von Willebrand factor (ULvWF) from endothelium. Circulating a disintegrin-like and metalloprotease with thrombospondin type I repeats (ADAMTS)-13 may be consumed through the ongoing cleavage of ULvWF, resulting in a secondary deficiency of ADAMTS-13 in DIC. We determined whether ADAMTS-13 activity showed a significant correlation with the activation status of the coagulation system and hospital mortality in DIC. Materials and methods: ADAMTS-13 activity was assayed by fluorescence resonance energy transfer assay in 97 patients who were clinically suspected to have DIC. Results: ADAMTS-13 activity gradually decreased based on the DIC score and D-dimer levels and was correlated with the antithrombin level, representing the consumption of ADAMTS-13 during the ongoing coagulation process. There were no correlation between ADAMTS-13 activity and neutrophil CD64 expression as a neutrophil activation marker and circulating IL-6 level as an inflammatory marker. Patients with a low activity of ADAMTS-13 (<= 56.4%) had a poor survival rate compared to patients with a high activity of ADAMTS-13. Conclusions: We conclude that ADAMTS-13 activity is strongly correlated with the severity of coagulopathy and hospital mortality. ADAMTS-13 may serve as a diagnostic and prognostic marker of DIC. (C) 2008 Elsevier Ltd. All rights reserved.Song SH, 2008, THROMB RES, V121, P499, DOI 10.1016/j.thromres.2007.05.013Martin K, 2007, CRIT CARE MED, V35, P2375, DOI 10.1097/01.CCM.0000284508.05247.B3Lam JK, 2007, J THROMB HAEMOST, V5, P1010Toh CH, 2007, J THROMB HAEMOST, V5, P604Nguyen TC, 2007, HAEMATOL-HEMATOL J, V92, P121Turner N, 2006, J THROMB HAEMOST, V4, P1396Ono T, 2006, BLOOD, V107, P528, DOI 10.1182/blood-2005-03-1087Liu L, 2005, J THROMB HAEMOST, V3, P2536Reiter RA, 2005, THROMB HAEMOSTASIS, V93, P554, DOI 10.1160/TH-04-08-0467Crawley JTB, 2005, BLOOD, V105, P1085, DOI 10.1182/blood-2004-03-1101Bakhtiari K, 2004, CRIT CARE MED, V32, P2416, DOI 10.1097/01.CCM.0000147769.07699.E3Dhainaut JF, 2004, J THROMB HAEMOST, V2, P1924Bernardo A, 2004, BLOOD, V104, P100Dempfle CE, 2004, THROMB HAEMOSTASIS, V91, P812, DOI 10.1160/TH03-09-0577Mannucci PM, 2003, HAEMATOLOGICA, V88, P914Reiter RA, 2003, BLOOD, V101, P946, DOI 10.1182/blood-2002-03-0814Moake JL, 2002, NEW ENGL J MED, V347, P589Bianchi V, 2002, BLOOD, V100, P710Mannucci PM, 2001, BLOOD, V98, P2730Taylor FB, 2001, THROMB HAEMOSTASIS, V86, P1327Levy GG, 2001, NATURE, V413, P488Levi M, 1999, NEW ENGL J MED, V341, P586Tsai HM, 1998, NEW ENGL J MED, V339, P1585