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Increased mortality in systemic inflammatory response syndrome patients with high levels of coagulation factor VIIa
Author(s) -
Hyseni A.,
Kemperman H.,
Lange D. W.,
Groot P. G.,
Linssen M.,
Kesecioglu J.,
Lisman T.,
Roest M.
Publication year - 2013
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.12427
Subject(s) - medicine , systemic inflammatory response syndrome , factor vii , tissue factor , gastroenterology , sepsis , hazard ratio , factor viia , confidence interval , coagulation
Summary Background The tissue factor ( TF )‐ Factor VII a ( FVII a) complex has a pivotal role in inflammatory and coagulation responses in patients with systemic inflammatory response syndrome ( SIRS ) and sepsis. Because zymogen FVII ( FVII ) and FVII a compete for binding to TF , their plasma levels determine if a catalytically active TF ‐ FVII a complex will be formed. Objective To study mortality in SIRS patients as a function of FVII a and FVII levels in plasma. Methods This was a cohort study of 275 patients presenting with SIRS , aged 18 years or older and with an anticipated Intensive Care Unit ( ICU ) stay of at least 24 h. FVII a was measured using a novel, quantitative assay that recognizes FVII a, but not FVII . All‐cause hospital mortality was followed over a period of 60 days. Results The percentage of FVII measured as FVII a was higher in non‐survivors than survivors (2.8%, IQR = 1–5.5% vs. 1.5%, IQR = 0.6–3.3%; P = 0.034). High levels of FVII a were associated with decreased 60‐day cumulative survival (62% vs. 81%, P = 0.030); the opposite was observed for FVII (84% vs. 76%, P = 0.039). Patients with high‐ FVII a and low‐ FVII levels had a three‐fold increased hazard ratio ( HR ) compared with the patients that had low‐ FVII a and high‐ FVII levels ( HR = 3.24, 95% confidence interval [ CI ] = 1.41–7.36). This association persisted after adjusting for the APACHE IV score (adjusted HR = 2.75, 95% CI = 1.2–6.27). Conclusions SIRS patients with high‐ FVII a and low‐ FVII on admission have an increased mortality risk, an association that is independent from the parameters included in the APACHE IV score.