PURPOSE: Severe Sepsis(SS)is associated with acute organ dysfunction. An abnormal activation of the coagulation system may result in a thrombotic obstruction of the microvasculature, and contribute to the pathogenesis of organ failure. The Sepsis-Associated-Coagulopathy(SAC)also includes dysfunctional endogenous anticoagulant pathways. Considering that SAC may contribute to organ failure, a decrease in the levels of Protein-C(PC)and Antithrombin-III(AT-III)could identify patients at risk to develop SS and Multisystem Failure(MF).
METHODS: All 26 patients included were hospitalized in the ICU with a diagnosis of sepsis. They were screened for these variables:serial dosage of PC and AT-III, all cause mortality during hospitalization, number of organs showing acute dysfunction, Intubation and Assisted-Ventilation(IAV), requirement of Vasopressor Agents(VA), and sites of infections.
RESULTS: All cause mortality was 62%(16/26). 92% of the patients(24/26)developed SS, with an average of 4.3 dysfunctional organs per patient. IAV was required in 85% of the patients(22/26), and VA in 77%(20/26). A fall in PC was observed in 75% of the patients with SS(18/24)and in 81% of the ones who died(13/16). A fall in AT-III was seen in 91% of the patients with SS(20/22)and in 100% of the ones who died(14/14). A significant decrease in the platelet count was documented in 29% of the patients with SS(7/24)and DIC in another 21%(5/24).
CONCLUSION: A decrease in the levels of PC and AT-III may identify patients at risk of developing SS and MF. The fall in PC and AT-III may even precede the onset of symptoms by hours. Therefore, a combination of these markers could determine high risk patients, and accelerate our therapeutic interventions.
CLINICAL IMPLICATIONS: Reliable markers capable of predicting patients at risk for SS and MF are needed. Presently, the only haematological criteria of acute organ dysfunction(for giving Drotrecogin Alfa)is based on the platelet count. In our study, 29% of the patients with SS presented a significant decrease in the platelets, and another 21% were diagnosed with DIC; while 75% showed a fall in PC and 91%in AT-III. Moreover,the decrease in PC and AT-III in SS may occur earlier than a fall in the platelet count or the appearance of a DIC. Consequently, PC and AT-III could represent useful markers in the initial evaluation of the septic patient.
DISCLOSURE: Jean Mathieu, None.