Relation between coagulation/fibrinolysis and lactate in the course of human septic shock

Hartemink, Koen J.; Hack, C. E.; Groeneveld, A. B. Johan

doi:10.1136/jcp.2010.079707

Cited by 14 publications

(13 citation statements)

References 37 publications

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“…Coagulation activation and inhibition of fibrinolysis may aggravate microcirculatory dysfunction by disseminated intravascular coagulation [33]. Lower platelet counts in septic patients with hyperlactatemia were observed in the present study comparable with previous results [20] and might be a marker of this process.…”

Section: Discussionsupporting

confidence: 92%

Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock

Thomas-Rueddel

Poidinger

Weiß

et al. 2015

Journal of Critical Care

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Section: Discussionsupporting

confidence: 92%

Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock

Thomas-Rueddel

Poidinger

Weiß

et al. 2015

Journal of Critical Care

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“…The earlier elevation in D-dimer and increased lysis (versus no lysis) observed in the FIBTEM lysis tests in the HS group, compared to the HS+ and HS++ groups, indicate that soft tissue and musculoskeletal injuries inhibit the fibrinolytic process. The current findings are supported by a simplified assay described by Hartemink et al 7 in that NHPs with tissue injury in addition to HS have suppressed ratios of D-Dimer to lactate compared to animals with HS alone. Clinically, the diagnosis of fibrinolysis by ROTEM has been made based on the tissue factor-based EXTEM test.…”

Section: Discussionsupporting

confidence: 76%

“…6,7,9,10,15,16,21 Previous work in rats has revealed an innate resistance to tPA-mediated fibrinolysis, which is decreased after HS but increased with tissue injury. 16 This is further supported in a swine model of a severe blast injury which produces a hypercoagulable state rather than a bleeding coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Tissue injury suppresses fibrinolysis after hemorrhagic shock in nonhuman primates (rhesus macaque)

Macko

Moore

Andrew

et al. 2017

Journal of Trauma and Acute Care Surgery

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BACKGROUND Hypoperfusion is associated with hyperfibrinolysis and early death from exsanguination, whereas tissue trauma is associated with hypofibrinolysis and delayed death from organ failure. We sought to elucidate the effects of injury patterns on fibrinolysis phenotypes using a nonhuman primate (NHP) model. METHODS NHPs were randomized to three injury groups (n = 8/group): 60 minutes severe pressure-targeted controlled hemorrhagic shock (HS); HS + soft tissue injury (HS+); or HS + soft tissue injury + femur fracture (HS++). Animals were resuscitated and monitored for 360 minutes. Blood samples were collected at baseline, end-of-shock, end-of-resuscitation (EOR), and T = 360 minutes for assessments of: severity of shock (lactate) and coagulation via prothrombin time, partial thromboplastin time, D-dimer, fibrinogen, antithrombin-III, von Willebrand factor, and viscoelastic testing (ROTEM). Results are reported as mean ± SEM; statistics: two-way analysis of variance and t-tests (significance: p < 0.05). RESULTS Blood loss, prothrombin time, partial thromboplastin time, antithrombin-III, fibrinogen, and von Willebrand factor were equivalent among groups and viscoelastic testing revealed few differences throughout the study. D-dimer increased approximately threefold, at EOR in the HS group, and at T = 360 minutes in the HS+ and HS++ groups (p < 0.05). At EOR, in the HS group compared with the HS+ and HS++ groups; the D-dimer-lactate ratio was twofold greater (2.2 ± 0.3 vs. 1.1 ± 0.3 and 1.1 ± 0.2, respectively; p < 0.05) and tissue factor-activated fibrin clot 30-minute lysis index was lower (98 ± 1% vs. 100 ± 0% and 100 ± 0%, respectively; p < 0.05). CONCLUSION NHPs in HS exhibit acute suppression of fibrinolysis in the presence of tissue injury. Additional assessments to more comprehensively evaluate the mechanisms linking tissue injury with the observed fibrinolysis shutdown response are warranted.

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“…The rate of resolution of DIC was highest in the patients with sepsis without other infections, suggesting that this condition includes many catheter infections that do not affect organ failure in the early stage of infectious DIC. Catheter infections frequently cause sepsis and abnormalities associated with blood coagulation, such as DIC (28,29). In this study, the patients with DIC caused by respiratory infections exhibited the lowest rate of resolution of DIC and the highest mortality rate.…”

Section: Discussionmentioning

confidence: 63%

A Prospective Analysis of Disseminated Intravascular Coagulation in Patients with Infections

et al. 2013

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Objective Disseminated intravascular coagulation (DIC) is often associated with infection and a poor outcome. In this study, useful markers for predicting poor outcomes were examined. Methods The frequency of DIC and organ failure, outcomes and hemostatic markers were prospectively evaluated in 242 patients with infections. Results Seventy-seven patients were diagnosed with DIC, 36 of whom recovered from the condition. The rate of DIC or resolution of DIC was highest in the patients with sepsis and lowest in the patients with respiratory infections. Mortality tended to be high in the patients with respiratory infections. The DIC score, sepsis-related organ failure assessment (SOFA) score, prothrombin time (PT) ratio and thrombin-antithrombin complex level were significantly high in the patients who did not recover from DIC. The age, DIC score, SOFA score, PT ratio and levels of thrombomodulin and plasminogen activator inhibitor (PAI)-I were significantly high in the non-survivors. Factors related to a poor outcome included resolution of DIC, the SOFA score, age and the PT ratio. Factors related to resolution of DIC included the SOFA score and age, while factors related to the SOFA score included the levels of PAI-I, leukocytes, fibrinogen, D-dimer and platelets. Conclusion The outcomes of septic patients primarily depend on the SOFA score and the resolution of DIC, which are related to organ failure.

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Relation between coagulation/fibrinolysis and lactate in the course of human septic shock

Abstract: The course of human septic shock, particularly inhibition of activated fibrinolysis during DIC, may be independently associated with hyperlactataemia; therefore a coagulation/fibrinolysis imbalance may contribute to tissue hypoxygenation and ultimately thereby to demise.

Cited by 14 publications

References 37 publications

Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock

Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock

Tissue injury suppresses fibrinolysis after hemorrhagic shock in nonhuman primates (rhesus macaque)

A Prospective Analysis of Disseminated Intravascular Coagulation in Patients with Infections

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