SESSION TITLE: Sepsis and Shock Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: Severe Sepsis(SS)is associated with acute organ dysfunction.Different mechanisms are involved in the development of organ failures.Hemodynamic instability is the most important.Systemic inflammation,associated with SS,leads to production of pro-inflammatory cytokines.This can induce a procoagulant state:Activation of the Coagulation Cascade,Down-Regulation of Natural Anticoagulants,Inhibition of Endogenous Fibrinolysis.Fibrin formation and deposition,may produce thrombii in the microvasculature,disrupt blood flow to vital organs,and give rise to a Multiple Organ Dysfunction Syndrome(MODS).
METHODS: Definition of DIC is based on a scoring system,that uses biomarkers:Platelets,PT,D-Dimers,Fibrinogen.We have changed it,by adding Protein-C(PC) and Antithrombin(AT),two Natural Anticoagulants,and deleting Fibrinogen,an acute phase reactant.74 patients,in the ICU with a diagnosis of sepsis,were screened for:All-cause mortality during hospital stay,Number of Organs showing an acute Dysfunction(NOD),Hematologic Biomarkers,Calculation of our Novel Hemostatic Score(HS)described in Dec.2012:CritCareMed.Suppl.Abstract:818,and Oct.2014:CHEST:146.Suppl.MeetingAbstracts:233A.
RESULTS: All-cause mortality was 55%(41/74).The 41 patients who died had an average of 5.5NOD,while the 33 survivors had a mean NOD of 3.5(p<0.001).Patients who died showed an average HS of 8.8 points,compared to 6.6 in survivors(p=0.001).A significant difference in PC was noted between patients who died(0.34Un/l),compared with those who survived(0.53Un/l)(p<0.001).AT values were respectively 0.41Un/l and 0.55Un/l in patients who died,compared to survivors(p=0.003).Average Platelet counts were 101 in patients who died,and 154 in survivors(p=0.011).
CONCLUSIONS: Our study showed a significant relationship between the severity of Sepsis-Associated Coagulopathy(SAC),and a worse clinical outcome.Low values of Natural Anticoagulants PC and AT,and a high HS,were all related with an increased NOD,and a higher rate of MODS and mortality.
CLINICAL IMPLICATIONS: Restoring a normal perfusion pressure,may not be enough to prevent vital organs hypoxia,MODS,and death.DIC is now recognized as an independant predictor of mortality.Recombinant human Activated Protein-C(rhAPC),was withdrawn,because of poor results seen in PROWESS-SHOCK trial.But,Its main inclusion criterion was hemodynamic(septic shock),while rhAPC only has hematologic mechanisms of action.Past studies showed that patients who improved the most from getting rhAPC,were those with a SAC.New studies are needed.
DISCLOSURE: The following authors have nothing to disclose: Jean Mathieu, Sylvie Boucher
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