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Chest, Vol 103, 1107-1112, Copyright © 1993 by American College of Chest Physicians

ARTICLES

Elevated concentrations of cross-linked fibrin degradation products in plasma. An early marker of gram-negative bacteremia

SR Deitcher and PR Eisenberg
Cardiovascular Division, Washington University, St. Louis 63110.

PURPOSE: Because coagulant and fibrinolytic activity are increased by endotoxin, we hypothesized that concentrations of cross-linked fibrin degradation products, sensitive markers of plasmin activity, would be increased in patients with Gram-negative bacteremia. PATIENTS AND METHODS: Cross-linked fibrin degradation products were measured with an enzyme-linked immunosorbent assay (ELISA) based on a monoclonal antibody specific for cross-linked fibrin degradation products, and with a novel, semiquantitative hemagglutination assay based on the same antibody coupled to FAB' fragments from a monoclonal antibody against a universal red blood cell antigen. Blood samples were obtained from 100 consecutive emergency department patients evaluated for sepsis. RESULTS: Blood cultures were positive in 21 percent of the patients, 75 percent (12/21) with Gram-negative organisms. Elevations of cross- linked fibrin degradation products (normal < 200 ng/ml) were measured by ELISA in all patients (12/12) with Gram-negative bacteremia. The hemagglutination assay was positive in ten of these. Detectable increases in fibrinolytic activity occurred in all patients with Gram- negative bacteremia, even in the absence of clinical signs or laboratory evidence of sepsis or disseminated intravascular coagulation. The ELISA and hemagglutination assay had negative predictive values for Gram-negative bacteremia of 100 percent and 96 percent, respectively. CONCLUSION: Elevation of cross-linked fibrin degradation products consistent with increased fibrinolytic activity occurs in all patients with Gram-negative bacteremia. Accordingly, the lack of elevation may be clinically useful in identifying patients less likely to have Gram-negative bacteremia.


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 Arterioscler. Thromb. Vasc. Bio.Home page
L. V. Lee, G. A. Ewald, C. R. McKenzie, and P. R. Eisenberg
The Relationship of Soluble Fibrin and Cross-linked Fibrin Degradation Products to the Clinical Course of Myocardial Infarction
Arterioscler. Thromb. Vasc. Biol., April 1, 1997; 17(4): 628 - 633.
[Abstract] [Full Text]


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Copyright © 1993 by the American College of Chest Physicians.