Prognostic value of hemostasis-related parameters for prediction of organ dysfunction and mortality in sepsis
Clinical manifestations of sepsis are not caused directly by the invading pathogens, but rather mostly by systemic inflammation that leads to activation of the coagulation system. The aim of this study was to determine whether levels of hemostasis-related parameters measured in intensive care unit admissions are associated with mortality and severity in patients with sepsis. Materials and methods: Eighty-five patients who fulfilled criteria for a diagnosis of sepsis were included in our study. Platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time, D-dimer, and fibrinogen levels were determined within the first 24 h from sepsis onset. Differences between groups of septic patients were assessed by Mann-Whitney U test and Kruskal-Wallis test. Logistic regression analysis was performed to test the joint effect of different predictors. Results: Prolonged aPTT and PT with higher D-dimer concentrations in patients with sepsis are associated with more severe forms of the disease. aPTT was prolonged in nonsurvivors, while platelet count and fibrinogen levels were higher in survivors. Platelet count and aPTT ratio are independent predictors of fatal outcome in our logistic regression model. Conclusion: Hemostasis-related parameters have a significant impact on severity and outcome in sepsis.
Prognostic value of hemostasis-related parameters for prediction of organ dysfunction and mortality in sepsis
Clinical manifestations of sepsis are not caused directly by the invading pathogens, but rather mostly by systemic inflammation that leads to activation of the coagulation system. The aim of this study was to determine whether levels of hemostasis-related parameters measured in intensive care unit admissions are associated with mortality and severity in patients with sepsis. Materials and methods: Eighty-five patients who fulfilled criteria for a diagnosis of sepsis were included in our study. Platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), thrombin time, D-dimer, and fibrinogen levels were determined within the first 24 h from sepsis onset. Differences between groups of septic patients were assessed by Mann-Whitney U test and Kruskal-Wallis test. Logistic regression analysis was performed to test the joint effect of different predictors. Results: Prolonged aPTT and PT with higher D-dimer concentrations in patients with sepsis are associated with more severe forms of the disease. aPTT was prolonged in nonsurvivors, while platelet count and fibrinogen levels were higher in survivors. Platelet count and aPTT ratio are independent predictors of fatal outcome in our logistic regression model. Conclusion: Hemostasis-related parameters have a significant impact on severity and outcome in sepsis.
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- Dombrovskiy VY, Martin AA, Sunderram J Paz HL. Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: a trend analysis from 1993 to 2003. Crit Care Med 2007; 35: 1244–1250.
- Charalampos P, Vincent JL. Sepsis biomarkers: a review. Crit Care 2010; 14: R15.
- Breslow M, Badawi O. Severity scoring in the critically ill. Part 1-Interpretation and accuracy of outcome prediction scoring systems. Chest 2012; 141: 245–252.
- Giannoni C, Chelazzi C, Villa G, Raffaele De Gaudio A. Organ dysfunction scores in ICU. Trends in Anaesthesia and Critical Care 2013; 3: 89–96.
- Schouten M, Wiersinga WJ, Levi M. Inflammation, endothelium, and coagulation in sepsis. J Leukocyte Biol 2008; 83: 536–545.
- Totan M, Dilber C, Albayrak D. Protein C, protein S and antithrombin III levels in a rabbit sepsis model. Turk J Med Sci 1999; 29: 389–391.
- Yıldız BD, Yorgancı K. Current trends and future implications in sepsis treatment. Turk J Med Sci 2008; 38: 501–510.
- Battah AA, El Gohary TS, Ashraf M. Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis. Journal of American Science 2010; 6: 382–388.
- Levi M. The coagulant response in sepsis and inflammation. Hämostaseologie 2011; 1: 10–16.
- Levi M, van der Poll T, Büller HR. Bidirectional relation between inflammation and coagulation. Circulation 2004; 109: 2698–2704.
- Levi M. Coagulation. In: Cavaillon JM, Adire C, editors. Sepsis and Non-Infectious Systemic Inflammation. From Biology to Critical Care. Weinheim, Germany: Wiley-VCH Verlag; 2009. pp. 251–278.
- Lissalde-Lavigne G, Combescure C, Muller L, Bengler C, Raillard A, Lefrant JY, Gris JC. Simple coagulation tests improve survival prediction in patients with septic shock. J Thromb Haemost 2008; 6: 645–645.
- Bone R, Balk R, Cerra F, Dellinger R, Fein A, Knaus W, Schein R, Sibbald W. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–1655.
- Levy M, Fink M, Marshall J, Abraham E, Angus D, Cook D, Cohen J, Opal S, Vincent JL, Ramsay G. 2001 SCCM/ESICM/ ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250–1256.
- Hamzaoui O, Carlet J. Organ dysfunctions during severe sepsis and septic-like syndromes: epidemiology, classification, and mechanisms. In: Cavaillon JM, Adire C, editors. Sepsis and Non-Infectious Systemic Inflammation. From Biology to Critical care. Weinheim, Germany: Wiley-VCH Verlag; 2009. pp. 57–76.
- Mihajlovic D, Draskovic B, Brkic S, Mitic G, Lendak D. Endothelial dysfunction and interaction between inflammation and coagulation in sepsis and systemic inflammatory response syndrome (SIRS). Health Med 2012; 6: 1309–1314.
- Angstwurm MWA, Dempfle CE, Spannagl M. New disseminated intravascular coagulation score: a useful tool to predict mortality in comparison with Acute Physiology and Chronic Health Evaluation II and Logistic Organ Dysfunction scores. Crit Care Med 2006; 34: 314–320.
- Oh D, Jang MJ, Lee SJ, Chong SY, Kang MS, Wada H. Evaluation of modified non-overt DIC criteria on the prediction of poor outcome in patients with sepsis. Thromb Res 2010; 126: 18–23.
- Paulus P, Jennewein C, Zacharowski K. Biomarkers of endothelial dysfunction: can they help us deciphering systemic inflammation and sepsis? Biomarkers 2011; 16 (Suppl. 1): 11– 21.
- Xing K, Murthy S, Liles WC, Singh JM. Clinical utility of biomarkers of endothelial activation in sepsis-a systematic review. Crit Care 2012; 16: R7.
- Fourrier F. Severe sepsis, coagulation, and fibrinolysis: dead end or one way? Crit Care Med 2012; 40: 2704–2708.