Global fibrinolytic capacity in pediatric patients with sepsis and disseminated intravascular coagulation

Abstract

There are many complex pathophysiologic changes of the coagulation system in sepsis. The fibrinolytic system was evaluated in septic children using the global fibrinolytic capacity (GFC), a new technique reflecting the overall fibrinolytic activity. The study consisted of 24 children with sepsis, 36 children with sepsis plus disseminated intravascular coagulation (DIC), and 20 healthy age-matched control individuals. Compared with controls, 86% of sepsis patients and 87% of sepsis plus DIC patients had decreased GFC levels. Between the sepsis plus DIC and sepsis groups there was no significant difference in terms of GFC levels. While 19 patients (52.7%) died in the sepsis plus DIC group, only three patients (12.5%) died in the sepsis group. When survivors and nonsurvivors were compared in terms of coagulation tests, there were significant differences for protein C, antithrombin, platelet, fibrinogen, aspartate aminotransferase, alanine aminotransferase, prothrombin time, and white blood cell values. In conclusion, the level of GFC reduced in most of the pediatric sepsis patients but no difference was observed between patients with sepsis and patients with sepsis plus DIC. While inhibition of fibrinolysis is an important finding in sepsis, the mortality is mainly associated with the presence of end-organ damage and the status of coagulation parameters.

Global Fibrinolytic Capacity in Neonatal Sepsis

“…Coagulopathy and inflammation-related severe sepsis often lead to end-organ damage and high mortality rate. [5][6][7][8] Thrombocytopenia was detected in 35% patients in this study. No significant difference was detected in terms of platelet counts when the patient group and control group were compared.…”

“…[1][2][3][4] The systemic host response to infection has been associated with coagulation activation, consumption of anticoagulation factors, and inhibited fibrinolysis. 5 Various abnormalities of the hemostatic markers concerning coagulation, procoagulant state, and fibrinolytic system are risk factors for sepsis and associated multiorgan failure in newborn infants. 5 Current studies reported that the hypofibrinolytic and hypercoagulable states play an essential role in the development of multiorgan failure in patients with sepsis.…”

“…5 Various abnormalities of the hemostatic markers concerning coagulation, procoagulant state, and fibrinolytic system are risk factors for sepsis and associated multiorgan failure in newborn infants. 5 Current studies reported that the hypofibrinolytic and hypercoagulable states play an essential role in the development of multiorgan failure in patients with sepsis. [6][7][8] There are some data about hemostatic abnormalities including alterations of circulating coagulation proteins and impaired fibrinolytic activity in patients with sepsis.…”

Differential protein expression in patients with urosepsis

“…Survivors and non-survivors show significant differences in anti-thrombin as revealed by coagulation tests. 25 , 26 …”

Sulfasalazine treatment can cause a positive effect on LPS-induced endotoxic rats

“…Whereas, fibrinogen can inhibit by inactivation of the NF-κB pathway [ 42 ] and the decrease of fibrinogen levels can be caused by decreased synthesis, use in clotting, and increased vascular permeability [ 33 , 45 ]. However, in some studies plasma fibrinogen and ATIII levels did not change in septic shock animals [ 4 , 7 ]. In the current study, LPS administration at a dose of 4 mg/kg may have partially induced the intravascular coagulation mechanism.…”