Prognostic value of selected hypercoagulability markers in sepsis. A prospective study

Abstract

Introduction. Sepsis is a heterogeneous syndrome caused by an unbalanced host response to an infection, resulting in organ dysfunction. Disseminated intravascular coagulation (DIC) varies widely from 30 % to 60 % and depends on different scoring systems. An overt DIC easily identified, while the pre-existing phase of hypercoagulability can’t be detected by screening coagulation tests. Preventive DIC treatment is hardly possible without an early diagnostics. Objectives. The aim of the study is identifying the hypercoagulabiliy markers in septic patients with hypercoagulability pattern on thromboelastometry (TEM) and matching them to the outcome. Materiasl and methods. ROTEM screening of septic patients revealed 85 ones with pattern of hypercoagulability. Thrombin generation test with thrombomodulin, screening coagulation tests, anticoagulants levels and selected hypercoagulability markers were performed from frozen plasma samples. According to the outcome patients were divided to survivors and nonsurvivors. Results. The survivors group included 62 patients and nonsurvivors — 19. Thrombin generation test revealed only 7 cases of hypercoagulability. There was no significant difference in endogenous thrombin potential 20 (10; 25) % vs 14 (10; 31) % and peak thrombin 8 (2,9; 16) % vs 7 (3; 18) % in survivors and nonsurvivors, respectively. Other significant differences between survivors vs nonsurvivors are: protein C 79,5 ± 28 % vs 64,9 ± 25 %, FVIII 226,4 ± 66 % vs 276,6 ± 94 % , von Willebrand factor 269 ± 129 % vs 435 ± 181 %, Аntithrombin 82 (60; 94) % vs 65 (41; 80) %, and D-dimer 2157 (1341; 3964) mcg/l vs 3253 (1911; 6914) mcg/l, respectively. Conclusion. Septic patients with TEM criteria of hypercoagulability may have unique set of thrombophilia markers. Local screening coagulation tests do not affect the prognosis. Low level of protein C and antithrombin, as well as high FVIII, von Willebrand factor, D-dimer worsen outcome.