Investigation of Hemostatic Changes in Patients with Sepsis

Abstract

Background : It is known that severe infection and inflammation lead to hemostatic abnormalities. Recently, much attention is focused on the mechanisms of infection or inflammation and on how it plays a central role in effecting the coagulation system. Disseminated intravascular coagulation in particular, is a common phenomenon in patients with sepsis, but the clinical implications of this condition are not clear. Therefore we attempted to evaluate the changes of the coagulation system in patients with sepsis and studied the factors that lead to such changes.Methods : One hundred one patients diagnosed with sepsis were enrolled in this study. The patients were clinically evaluated for underlying disease and data for inflammatory status and coagulative changes were evaluated retrospectively.Results : The WBC count increased in 76% and decreased in 6% of sepsis patients in comparison to the reference interval. The platelet count decreased in 65.3%. Changes in coagulative tests such as prothrombin time, activated partial thromboplastin time, antithrombin III, and D-dimer were observed in 70.4%, 52.7%, 87.2% and 100% of the patients, respectively. Correlation between ESR and fibrinogen was the highest in relation to the other coagulation factors. CRP also showed the highest correlation with fibrinogen in contrast to the other coagulation factors.Conclusions : This study confirmed the clear activation of coagulation in patients with sepsis. Of the evaluated factors involved in coagulation and fibrinolysis, fibrinogen showed the highest correlation to indices representing the inflammatory state. However further studies on the anticoagulant pathway are necessary in elucidating this matter. (Korean J Lab Med 2007;27:157-61)

Performance Evaluation of Five Different Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Predicting Mortality in Patients with Complicated Sepsis

“…As a result, the prolongation of aPTT may be masked by an increase in factor VIII levels in early sepsis patients with DIC. Kinasewitz et al ( 20 ) and Kim et al ( 19 ) reported that the abnormality rate in PT is hihger than that in aPTT (93.4% vs. 63.1% and 68.4% vs. 47.3%, respectively) for patients with sepsis. In conclusion, we suggest that PT is an early marker for the detection of DIC, and aPTT is a marker for the reflection of severity in DIC.…”

“…Gando et al ( 7 ) made the R-JAAM criteria based on the little effect of fibrinogen level on the prediction of outcome in the DIC patients. However, Kim et al ( 19 ) showed that the OR of the low fibrinogen level (< 1.0 g/L) is 2.13 ( P = 0.024) and Gando et al ( 16 ) reported that the fibrinogen is an independent predictor for 28-day mortality (OR 0.998, P = 0.033). The present study showed that fibrinogen on Day 1 transformed to nominal variable is an independent predictor for ICU mortality in univariable analysis.…”

De Marco Formula effectiveness as an adjunctive therapy to prevent infected ischemic diabetic foot amputation and reduce plasma fibrinogen

“…Fibrinogen increase, an acute-phase protein, is also observed in diabetic patients without vascular diseases [10e13] as well as in patients with sepsis [14]. A high fibrinogen concentration is among the factors promoting nutritive capillary blood flow disruption leading to tissue ischemia [15] and some evidence suggests a diabetic foot amputation risk factor.…”

Role of d-dimer testing in severe pelvic inflammatory disease: a new usable marker to assess the need for fertility-impairing surgery?

“…Activation of the coagulation cascade has also been described in so-called inflammation-induced coagulation (14), in which some proinflammatory cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and the tumor-necrosis factor (TNF), determine an increased inducible tissue factor expression in some cell types, such as endothelial cells and monocyte-derived macrophages (4,5).…”

“…Basic inclusion criteria were: [1] diagnosis of PID on patient's admission to hospital (based on clinical evaluation, laboratory reports, ultrasonographic examination, and, for surgical patients, on laparoscopy/laparotomy evidence), confirmed on discharge; [2] lack of subjective and/or objective findings, either suggestive or indicative of ongoing thromboembolic processes or of other diseases related to elevated D-dimer values; [3] lack of subjective and/or objective findings, either suggestive or indicative of other diseases (e.g., endometriosis, ectopic pregnancy) with similar clinical features; [4] declared desire to maintain reproductive organs; and [5] no reported history of sexually transmitted diseases.…”