RESUMO
This prospective study aimed at evaluation of the role of tissue factor pathway inhibitor [TFPI] as a predictor of disseminated intravascular coagulation [DIC] among patients with sepsis who were admitted to the PlCU at Alexandria University Children's Hospital over a period of 15 month starting from September 2002. Study subjects comprised 20 children with suspected or. Pre-DIC, 10 children with overt DIC and 10 healthy children served as a control group. Both patients and control groups were evaluated for platelet count, prothrombin activity, aPTT, plasma fibrinogen, AT III %, FDPs, and TFPI. These hemostatic parameters were followed every other day for patients with pre-DIC, while performed once for overt DIC and control groups. Pre-DIC patients with good outcome showed increase in their prothrombin activity, AT III, fibrinogen; decrease in FDPs and slight decrease in aPTT. On the contrary, poor outcome was associated with further decrease in prothrombin activity, AT Ill, fibrinogen, and increase in FDPs, and slight decrease in aPTT. TFPI increased in both survivors and no survivors; however, the final figure was higher in the survivors. TFPI it] patients with overt DIC showed higher significant values in the survivors compared to no survivors
Conclusion: increased level of TFPI in DIC reflect the depletion of the endothelial cell bound TFPl pool with loss of endothelial protective effect. Its therapeutic use in sepsis is based on this concept; TFPI could be used in following the patients with DIC, however, its high cost limit ifs use as a prognostic parameter in DIC