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Sepsis-Associated Coagulopathy: Diagnosis With Hematologic Biomarkers and Role in the Development of Multiple Organ Dysfunction Syndrome and Mortality FREE TO VIEW

Jean-Francois Mathieu, MD; Sylvie Boucher, MS; Rocky DiFruscia, DVM; Jean-Pierre Pellerin, MS
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University of Montreal, Montreal, QC, Canada

Chest. 2013;144(4_MeetingAbstracts):413A. doi:10.1378/chest.1674934
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Different mechanisms are involved in acute organ failure in Severe Sepsis(SS).Hemodynamic instability is the most important.In SS,the production of cytokines will induce a procoagulant state:Activation of the coagulation system,Down-regulation of natural anticoagulants,Inhibition of fibrinolysis.Fibrin deposition and formation of thrombi in the microvasculature may disrupt blood flow to vital organs,and give rise to a Multiple Organ Dysfunction Syndrome(MODS).The aim of our study was to evaluate a series of hematologic biomarkers to identify patients at risk of microcirculatory dysfunction and MODS.

METHODS: Definition of DIC is based on a scoring system that use biomarkers:platelets,PT,D-Dimers,and fibrinogen.We have modified this scoring system,by adding Antithrombin(AT)and Protein-C(PC),and deleting fibrinogen.74 patients admitted to the ICU with a diagnosis of sepsis,were screened for these criteria:All-cause mortality during hospital stay,Number of Organs showing an acute Dysfunction(NOD),Values of platelets,PT,D-Dimers,PC,AT,Calculation of our novel Hemostatic Score(HS)(cf.Dec.2012:CritCareMed.Suppl.Abstract:818).

RESULTS: All-cause mortality was 55%(41/74).The 41 patients that died had a mean NOD of 5.5,while the 33 survivors had an average NOD of 3.5(p<0.001).Patients that died had a mean HS of 8.8 points,while the score was 6.6 in survivors(p=0.001).Concerning PC,a significant difference was noted(p<0.001)between patients that died(0.34Un/l)and those that survived(0.53Un/l).AT values were respectively 0.41Un/l and 0.55Un/l in patients that died compared to survivors(p=0.003).

CONCLUSIONS: Links were seen between severity of the coagulopathy and clinical outcome,regarding NOD,MODS,and mortality.Low values of natural anticoagulants(PC,AT),and a high HS,were related with increased mortality.Thus,obstruction of the microvasculature may be an important factor,in addition to hemodynamic instability,in peripheral hypoperfusion,and development of MODS.

CLINICAL IMPLICATIONS: The microvasculature is probably involved in the pathophysiology of SS.Restoring normovolemia and perfusion pressure may not be enough to prevent regional hypoxia,MODS and ultimately death.A diagnosis of DIC is recognized as an independant predictor of mortality.Efficacy of recombinant Activated Protein-C(rAPC),through its anticoagulant and fibrinolytic effects,had been demonstrated,especially in groups of patients with a coagulopathy.Further studies,using hematologic markers and our HS,could seek for patients who may benefit from this drug.

DISCLOSURE: The following authors have nothing to disclose: Jean-Francois Mathieu, Sylvie Boucher, Rocky DiFruscia, Jean-Pierre Pellerin

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