The Value of Thrombus Markers Applied in Patients with Respiratory Failure
Thrombus Markers in Respiratory Failure
Abstract
Background: This work assessed the value of novel thrombus markers—thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), and tissue plasminogen activator-inhibitor complex (t-PAIC) applied in patients with respiratory failure (RF), including their role in predicting thrombus formation, evaluating prognosis, and assessing disease severity.
Methods: eighty patients with RF were enrolled and categorized into mild (n = 10), moderate (n = 9), and severe (n = 71) groups based on disease severity. Meanwhile, patients were also classified into thrombus (n = 14) and non-thrombus (n = 76) groups based on the presence of thrombus. Furthermore, they were assigned into survival (n = 70) and death (n = 20) groups based on prognosis. Traditional coagulation indicators, thrombus markers, infection-related parameters, and respiratory-related indicators were compared among patients in different groups. This work explored the predictive effects of these indicators on the degree of respiratory failure, thrombus formation, and prognosis in various patient groups. Additionally, correlations of thrombus markers and traditional coagulation indicators to respiratory-related indicators and infection-related indicators were analyzed.
Results: upon admission, levels of thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), and tissue plasminogen activator-inhibitor complex (t-PAIC) in the thrombus group were sharply higher in contrast to those in the non-thrombus group, showing obvious differences (P<0.05). Patients in the death group experienced remarkably elevated TAT, PIC, t-PAIC, thrombomodulin (TM), and to the survival group (P<0.05). In addition, high-sensitivity C-reactive protein (hs-CRP) in the death group was higher to that in the survival group (P<0.05). Platelet count (PLT) and procalcitonin (PCT) were sharply lower in the survival group (P<0.05). In groups of varying severity, PCT exhibited an elevated level in the severe, demonstrating great differences to the mild to moderate groups (P<0.05). Besides, TAT, PIC, TM, and t-PAIC showed higher sensitivity and accuracy in predicting severe RF, with higher specificity in predicting thrombus formation in RF patients. In correlation analysis, a positive correlation was observed between TT, PCT, and the fraction of inspired oxygen (FiO2). The activated partial thromboplastin time (APTT), PCT, and FiO2 exhibited positive correlations. Additionally, a positive association existed between fibrinogen (FIB), hs-CRP, and PLT. A positive link was identified between D-dimer and hs-CRP, PIC and PLT, as well as t-PAIC and PCT.
Conclusion: Thrombus markers exerted a crucial effect in patients experiencing respiratory failure, serving as pivotal indicators for assessing the severity of the condition, identifying thrombotic risk, and predicting prognosis.
References
2. Xu Z, Zhu L, Zhan J, Liu L. The efficacy and safety of high-flow nasal cannula therapy in patients with COPD and type II respiratory failure: a meta-analysis and systematic review. Eur J Med Res 2021; 26(1): 122.
3. Weatherald J, Parhar K, Al DZ, Chu DK, Granholm A, Solverson K, et al. Efficacy of awake prone positioning in patients with covid-19 related hypoxemic respiratory failure: systematic review and meta-analysis of randomized trials. Bmj-Brit Med J 2022; 379: e071966.
4. Odackal NJ, McCulloch MA, Hainstock MR, Vergales BD. Respiratory failure secondary to congenital pulmonary arterial thrombus with lung dysplasia. Bmj Case Rep 2019; 12(7): e227925.
5. Calverley PM. Respiratory failure in chronic obstructive pulmonary disease. Eur Respir J Suppl 2003; 47: 26s-30s.
6. Mazzolai L, Aboyans V, Ageno W, Agnelli G, Alatri A, Bauersachs R, et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J 2018; 39(47): 4208-18.
7. Howard L. Acute pulmonary embolism. Clin Med 2019; 19(3): 243-7.
8. Sapru A, Calfee CS, Liu KD, Kangelaris K, Hansen H, Pawlikowska L, et al. Plasma soluble thrombomodulin levels are associated with mortality in the acute respiratory distress syndrome. Intens Care Med 2015; 41(3): 470-8.
9. Andrianto, Al-Farabi MJ, Nugraha RA, Marsudi BA, Azmi Y. Biomarkers of endothelial dysfunction and outcomes in coronavirus disease 2019 (COVID-19) patients: A systematic review and meta-analysis. Microvasc Res 2021; 138: 104224.
10. Orwoll BE, Spicer AC, Zinter MS, Alkhouli MF, Khemani RG, Flori HR, et al. Elevated soluble thrombomodulin is associated with organ failure and mortality in children with acute respiratory distress syndrome (ARDS): a prospective observational cohort study. Crit Care 2015; 19: 435.
11. Di Nisio M, van Es N, Buller HR. Deep vein thrombosis and pulmonary embolism. Lancet 2016; 388(10063): 3060-73.
12. Jin X, Duan Y, Bao T, Gu J, Chen Y, Li Y, et al. The values of coagulation function in COVID-19 patients. Plos One 2020; 15(10): e0241329.
13. Asakura H, Ogawa H. COVID-19-associated coagulopathy and disseminated intravascular coagulation. Int J Hematol 2021; 113(1): 45-57.
14. Davie EW, Kulman JD. An overview of the structure and function of thrombin. Semin Thromb Hemost 2006; 32 Suppl 1: 3-15.
15. Lin Z, Sun H, Li D, Cai Z, Chen M, Zhang W, et al. Thrombin antithrombin complex concentration as an early predictor of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty. Bmc Musculoskel Dis 2022; 23(1): 574.
16. Zhou K, Zhang J, Zheng ZR, Zhou YZ, Zhou X, Wang LD, et al. Diagnostic and Prognostic Value of TAT, PIC, TM, and t-PAIC in Malignant Tumor Patients With Venous Thrombosis. Clin Appl Thromb-Hem 2020; 26: 1420597727.
17. Needleman L, Cronan JJ, Lilly MP, Merli GJ, Adhikari S, Hertzberg BS, et al. Ultrasound for Lower Extremity Deep Venous Thrombosis: Multidisciplinary Recommendations From the Society of Radiologists in Ultrasound Consensus Conference. Circulation 2018; 137(14): 1505-15.
18. Rezaie AR, Giri H. Anticoagulant and signaling functions of antithrombin. J Thromb Haemost 2020; 18(12): 3142-53.
19. Zanza C, Romenskaya T, Racca F, Rocca E, Piccolella F, Piccioni A, et al. Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness. Int J Mol Sci 2023; 24(8): 7118.
20. Jacobi J. Pathophysiology of sepsis. Am J Health-Syst Ph 2002; 59 Suppl 1: S3-8.
21. Zhong L, Dou J, Lin Q, He L, Zeng Q, Song J. Tissue-Type Plasminogen Activator-Inhibitor Complex as an Early Predictor of Septic Shock: A Retrospective, Single-Center Study. Dis Markers 2022; 2022: 9364037.
Copyright (c) 2024 Yingqun Chen, Zihan Yin, Junshi Wang, Cunliang Yan, Xuwei Lin, Lei Huang
This work is licensed under a Creative Commons Attribution 4.0 International License.
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.