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01.08.2012 | Original

Persistent hypocoagulability in patients with septic shock predicts greater hospital mortality: impact of impaired thrombin generation

verfasst von: Paul B. Massion, Pierre Peters, Didier Ledoux, Valentine Zimermann, Jean-Luc Canivet, Pierre P. Massion, Pierre Damas, André Gothot

Erschienen in: Intensive Care Medicine | Ausgabe 8/2012

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Abstract

Purpose

Sepsis induces hypercoagulability, hypofibrinolysis, microthrombosis, and endothelial dysfunction leading to multiple organ failure. However, not all studies reported benefit from anticoagulation for patients with severe sepsis, and time courses of coagulation abnormalities in septic shock are poorly documented. Therefore, the aim of this prospective observational cohort study was to describe the coagulation profile of patients with septic shock and to determine whether alterations of the profile are associated with hospital mortality.

Methods

Thirty-nine patients with septic shock on ICU admission were prospectively included in the study. From admission to day 7, analytical coagulation tests, thrombin generation (TG) assays, and thromboelastometric analyses were performed and tested for association with survival.

Results

Patients with septic shock presented on admission prolongation of prothrombin time, activated partial thromboplastin time (aPTT), increased consumption of most procoagulant factors as well as both delay and deficit in TG, all compatible with a hypocoagulable state compared with reference values (P < 0.001). Time courses revealed a persistent hypocoagulability profile in non-survivors as compared with survivors. From multiple logistic regression, prolonged aPTT (P = 0.007) and persistence of TG deficit (P = 0.024) on day 3 were strong predictors of mortality, independently from disease severity scores, disseminated intravascular coagulation score, and standard coagulation tests on admission.

Conclusions

Patients with septic shock present with hypocoagulability at the time of ICU admission. Persistence of hypocoagulability assessed by prolonged aPTT and unresolving deficit in TG on day 3 after onset of septic shock is associated with greater hospital mortality.

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Titel: Persistent hypocoagulability in patients with septic shock predicts greater hospital mortality: impact of impaired thrombin generation
verfasst von: Paul B. Massion
Pierre Peters
Didier Ledoux
Valentine Zimermann
Jean-Luc Canivet
Pierre P. Massion
Pierre Damas
André Gothot
Publikationsdatum: 01.08.2012
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 8/2012
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-012-2620-2

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Persistent hypocoagulability in patients with septic shock predicts greater hospital mortality: impact of impaired thrombin generation