The influence of hydroxyethyl starch on exogenous coagulation and active protein C in patients with septic shock

Abstract

To investigate the influence of hydroxyethyl starch solution on exogenous coagulation and active protein C ( APC ) in the patients with septic shock. A single-center prospective study was conducted. Eighty-four consecutive patients with septic shock admitted to intensive care unit ( ICU ) of Peking University People's Hospital from November 2009 to October 2014 were enrolled. The patients were randomized into two study groups by random digits table: Ringer lactate solution group ( RL group, n = 40 ) and hydroxyethyl starch group ( HES group, n = 44 ), and Ringer lactate solution or hydroxyethl starch 130/0.4 was used for resuscitation respectively. Peripheral blood was collected at four time points: before resuscitation, 6, 12, and 24 hours after resuscitation. The prothrombin time ( PT ), tissue factor ( TF ), tissue factor pathway inhibitor ( TFPI ) and APC were determined, and the length of ICU stay and the mortality were recorded. There were no significant differences in PT, TF, TFPI, and APC before and after resuscitation in RL group. No change in PT was found after resuscitation in HES group, and no significant difference was found as compared with RL group. TF after resuscitation in HES group was decreased gradually, and the level at the 24 hours after resuscitation was significantly lower than that before resuscitation ( U/L: 15.80±7.32 vs. 31.40±2.75, P<0.05 ); but there was no significant difference at all time points when compared with that of RL group ( all P>0.05 ). TFPI at 12 hours and 24 hours after resuscitation in HES group was increased when compared with before resuscitation ( μg/L: 1.32±0.22, 1.14±0.09 vs. 0.63±0.54 ). TFPI in HES group was significantly higher than that in RL group ( μg/L: 0.84±0.69, 0.95±0.30 ), but there was no significant differences between two groups ( both P>0.05 ). APC after resuscitation in HES group was decreased gradually, which was significantly lower than that in RL group at 6, 12, 24 hours after resuscitation ( mg/L: 3.38±3.00 vs. 5.98±4.12, 3.31±1.94 vs. 5.33±3.71, 3.42±2.64 vs. 7.53±4.67, P<0.05 or P<0.01 ). The length of ICU stay in HES group was significantly shorter than that in RL group ( days: 12.50±8.83 vs. 17.10±16.60, t = 9.037, P<0.001 ), but there was no significant difference in mortality between HES group and RL group [ 40.9% ( 18/44 ) vs. 60.0% ( 24/40 ), χ (2) = 2.339, P = 0.126 ]. Both RL and hydroxyethyl starch fluid resuscitation did not affect the PT of the patients. The use of hydroxyethyl starch probably inhibits excessive activation of the exogenous coagulation and hyper-coagulation in the early stage of sepsis, and inhibits activation of protein C as well.