Chest
Clinical Investigations in Critical CareTime Course of Hemostatic Abnormalities in Sepsis and its Relation to Outcome
Section snippets
Patients
With our Institutional Review Board approval, we studied 48 patients admitted to the medical ICU with the diagnosis of severe sepsis.14 At the time of hospital admission, all patients were in shock as defined by sepsis-induced hypotension, and the presence of signs of hypoperfusion, such as lactic acidosis, altered mental status, or oliguria.
Age (mean±SEM) was 57 ± 7.3 years. Apache II score was 20.2 ±2.9 in survivors and 25.3 ±2.3 in nonsurvivors. Twenty-one (43 percent) had positive blood
RESULTS
Results are summarized in Table 1. Patients with Gram-positive bacterial infections showed hemostatic abnormalities as severe as those with Gram-negative infections.
Fibrinogen plasma levels were high in both groups on days 1, 4, and 7. Levels in nonsurvivors on day 7 were significantly higher than in survivors. The vWF:Ag levels were elevated during the study period in both groups, with no particular trend. No significant differences were found between survivors and nonsiirvivors or between
DISCUSSION
Our results are consistent with a profound hemostatic derangement in patients with sepsis, characterized by coagulation activation and fibrinolysis activation and inhibition. Nonsurvivors presented signs suggestive of a more marked activation of coagulation and a stronger inhibition of fibrinolysis than survivors. Differences between survivors and nonsurvivors were not apparent at the time of hospital admission. Only serial measurements revealed a different profile depending on the outcome.
ACKNOWLEDGMENTS
We acknowledge the technical assistance of María Isabel Martínez de Tejada and Mariano Pérez Pascual and the invaluable collaboration of the nursing staff of our unit.
REFERENCES (46)
- et al.
Quantitation of tissue plasminogen activator in human endothelial cultures by use of an enzyme immunoassay
Thromb Res
(1984) - et al.
Changes in fibrinolysis in the intensive care patients
Thromb Res
(1987) - et al.
Extreme plasminogen activator inhibitor and endotoxin values in patients with meningococcal disease
Thromb Res
(1986) - et al.
Endotoxin induction of an inhibitor of plasminogen activator in bovine pulmonary artery endothelial cells
J Biol Chem
(1986) - et al.
Spontaneous fibrinolysis in whole human plasma: identification of tissue activator-related protein a<s the major plasminogen activator causing spontaneous activity in vitro
J Biol Chem
(1985) - et al.
Systemic and intestinal limits of O2 extraction in the dog
J Appl Physiol
(1987) - et al.
Coagulation and fibrinolysis activation in early sepsis
Am Rev Respir Dis
(1991) - et al.
Tumor necrosis factor and interleukin 1 in the serum of children with severe infectious purpura
N Engl J Med
(1988) Shock revisited
Pathol Annu
(1984)- et al.
Endotoxin and disease mechanisms
Annu Rev Med
(1987)
Endotoxinemia: an early predictor of septicemia in febrile patients
Lancet
Promotion and subsequent inhibition of plasminogen activation after administration of intravenous endotoxin to normal subjects
N Engl J Med
Elevated plasma levels of the anaphylotoxins C3a and C4a associated with a fatal outcome in sepsis
Am J Med
Anaphylatoxin generation in multisystem organ failure
J Trauma
Multiple-organ-failure syndrome
Arch Surg
Coagulation, fibrinolysis, and kallikrein systems in sepsis: relation to outcome
Crit Care Med
Plasminogen activator inhibitor 1: a new prognostic marker in septic shock
Thromb Haemost
Fibrinolysis and coagulation in patients with infectious disease and sepsis
Thromb Haemost
Measurement of urokinase-type plasminogen activator (u-PA) with an enzyme-linked immunosorbent assay (ELISA) based on three murine monoclonal antibodies
Thromb Hemost
Gerinnungsphysiologische Schnellmethode zur bestimmung des fibrinogens
Acta Haematol
Tissue oxygen exchange and reactive hyperemia following microembolization
J Surg Res
Protein S and C4b-binding protein in severe infection and septic shock
Thromb Hemost
Cited by (308)
Significance of plasma fibrinogen level and antithrombin activity in sepsis: A multicenter cohort study using a cubic spline model
2019, Thrombosis ResearchCitation Excerpt :Sepsis-induced coagulopathy is considered to be caused by both systemic intravascular activation of coagulation and microvascular endothelial injury, which leads to widespread thrombosis in the microvasculature and organ failure [4]. A number of studies have reported that coagulopathy in sepsis is associated with organ failure and is a risk factor for mortality [5–8]. Thus, to accurately evaluate coagulopathy in sepsis, various coagulation hemostatic markers, such as fibrin/fibrinogen degradation products (FDP), prothrombin time (PT), platelet count, fibrinogen, and antithrombin activity are clinically measured in sepsis patients.
Fibrinogen reflects severity and predicts outcomes in patients with sepsis and septic shock
2023, Blood Coagulation and Fibrinolysis