Plasma Endothelial Glycocalyx Components as a Potential Biomarker for Predicting the Development of Disseminated Intravascular Coagulation in Patients With Sepsis

Background: Sepsis coagulopathy or disseminated intravascular coagulation (DIC) mainly due to progressive endothelial disruption and damage. The glycocalyx is expressed on the endothelial cell surface and contributes to anti-thrombogenicity, anti-inflammatory, and regulates vascular permeability. We aimed to evaluate the clinical utility of plasma glycocalyx components as biomarkers in predicting the onset of DIC in sepsis. Materials and methods: This was a prospective observational study of 45 patients with sepsis (June to December 2018). Demographic, clinical (Acute Physiology, Age, Chronic Health Evaluation II [APACHE II], Sequential Organ Failure Assessment [SOFA]), and laboratory data from medical records were analyzed. Endothelial glycocalyx components (syndecan-1, heparan sulfate, hyaluronan) were measured using an ELISA kit. Results: Among the 45 patients (23, sepsis; 22, septic shock), plasma syndecan-1, heparan sulfate, and hyaluronan levels were higher in those with septic shock and were positively correlated with disease severity as determined by the APACHE II and SOFA scores and lactate levels. Receiver operating characteristic curve analysis revealed high sensitivity and specificity of syndecan-1 for predicting septic shock. Further, these levels were compared between patients with or without the development of DIC. Plasma syndecan-1 and hyaluronan levels were significantly elevated in patients with DIC compared to those in patients without DIC and were strongly associated with activated partial thromboplastin time, prothrombin time, and platelet counts. Area under the curve values for predicting DIC based on syndecan-1 and hyaluronan levels measurements were 0.774 and 0.740, respectively. Conclusions: Increased plasma syndecan-1 and hyaluronan levels may be indicators of disease severity and useful predictors for DIC development in sepsis.

Download Full-text

Evaluation of Disseminated Intravascular Coagulation in Critically Ill Pediatric Hemato-oncology Patients with Septic Shock

Thrombosis and Haemostasis ◽

10.1055/s-0040-1714737 ◽

2020 ◽

Vol 120 (11) ◽

pp. 1505-1511

Author(s):

Won Kyoung Jhang ◽

Seong Jong Park

Keyword(s):

Septic Shock ◽

Prognostic Factor ◽

Clinical Outcomes ◽

Critically Ill ◽

Disseminated Intravascular Coagulation ◽

Characteristic Curve ◽

Pediatric Intensive Care ◽

Mortality Prediction ◽

Oncology Patients ◽

Intravascular Coagulation

Abstract Background Disseminated intravascular coagulation (DIC) is a serious complication in septic shock. This study aimed to evaluate DIC and associated clinical outcomes using the International Society on Thrombosis and Hemostasis (ISTH) and modified ISTH overt DIC scores in critically ill pediatric hemato-oncology patients with septic shock. Methods Pediatric hemato-oncology patients with septic shock admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital between January 2013 and February 2020 were included. We modified the ISTH overt DIC score by eliminating the platelet domain and compared the performances of the ISTH and the modified ISTH overt DIC scores in DIC diagnosis and PICU mortality prediction of these patients. Results DIC was diagnosed in 56.4 and 38.5% of patients by ISTH and modified ISTH overt DIC scores, respectively. Patients with DIC showed a higher pediatric risk of mortality (PRISM) III, pediatric sequential organ failure assessment (pSOFA) scores, and PICU mortality than those without DIC (p < 0.05). The modified ISTH overt DIC score was an independent prognostic factor for PICU mortality and showed a larger area under the receiver operating characteristic curve than the ISTH overt DIC score (0.687 vs. 0.695). Addition of the DIC diagnosis improved the performance of PRISM III in predicting PICU mortality. Conclusion Critically ill pediatric hemato-oncology patients with septic shock frequently experience DIC, which was adequately evaluated by both ISTH and modified ISTH overt DIC scores. Considering the characteristics of these patients, the modified ISTH overt DIC score may be a promising prognostic factor for clinical outcomes in these critically ill pediatric patients.

Download Full-text

Septic Shock and Disseminated Intravascular Coagulation from Capnocytophaga Canimorsus Bacteremia After a Colonoscopy

10.26226/morressier.5ebc4ac6ffea6f735881a4d5 ◽

2020 ◽

Author(s):

Daniel Tsang ◽

Evan Siau

Keyword(s):

Septic Shock ◽

Disseminated Intravascular Coagulation ◽

Capnocytophaga Canimorsus ◽

Intravascular Coagulation

Download Full-text

Influence of antithrombin and argatroban on disseminated intravascular coagulation parameters in a patient with septic shock

Thrombosis Research ◽

10.1016/j.thromres.2008.10.010 ◽

2009 ◽

Vol 124 (3) ◽

pp. 383-386 ◽

Cited By ~ 1

Author(s):

Jan Beyer ◽

Kai Halbritter ◽

Matthias Weise ◽

Sebastian Schellong

Keyword(s):

Septic Shock ◽

Disseminated Intravascular Coagulation ◽

Coagulation Parameters ◽

Intravascular Coagulation

Download Full-text

Predictors of Disseminated Intravascular Coagulation in Patients with Septic Shock

ISRN Critical Care ◽

10.5402/2013/219048 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Diana J. Kelm ◽

Juan Carlos Valerio-Rojas ◽

Javier Cabello-Garza ◽

Ognjen Gajic ◽

Rodrigo Cartin-Ceba

Keyword(s):

Septic Shock ◽

Antiplatelet Therapy ◽

Disseminated Intravascular Coagulation ◽

Tertiary Care ◽

Multivariate Logistic Regression Model ◽

Care Hospital ◽

Clinical Predictors ◽

Intravascular Coagulation ◽

Early Goal Directed Therapy ◽

Increased Risk

Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, P<0.001). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC (P<0.001). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC (P<0.001). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay.

Download Full-text

Serum procalcitonin levels predict disseminated intravascular coagulation in patients with sepsis shock: A retrospective cohort study

10.21203/rs.3.rs-36566/v1 ◽

2020 ◽

Author(s):

Guang Fu ◽

Xi-si He ◽

Hao-li Li ◽

Hai-chao Zhan ◽

Jun-fu Lu ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Cohort Study ◽

Disseminated Intravascular Coagulation ◽

Area Under The Curve ◽

Multivariable Logistic Regression Model ◽

Intravascular Coagulation ◽

The Relationship ◽

Conventional Risk Factors

Abstract Background Complication of disseminated intravascular coagulation (DIC) is a determinant of the prognosis in patients with sepsis shock. Procalcitonin (PCT) has been advocated as a marker of bacterial sepsis. The purpose of this study was to evaluate the relationship between serum PCT levels and DIC with sepsis shock Methods A cohort study was designed which included patients that admitted in intensive care unit (ICU) between January 1, 2015 and December 31, 2018 and the follow-up to discharge. 164 septic shock patients were divided into DIC and non-DIC groups according to international society of thrombosis and homeostasis (ISTH). PCT was measured at the admission to ICU, and all the participants received routine biochemical coagulation test subsequently. Results PCT levels were considerably higher in septic shock patients who developed DIC than those who did not (54.6[13.6–200]vs12.6[2.4–53.3]ng/ml), respectively, P < 0.001). Multivariable logistic regression model revealed that PCT level was significantly associated with risk of DIC independent of conventional risk factors. In addition, curve fitting showed a linear relationship between PCT and DIC score. The Receiver Operating characteristic(ROC) curve suggested that the optimal cut-off point for PCT to predicting DIC induced by septic shock was 42.0 ng/ml, and the area under the curve (AUC) was 0.701(95% CI [0.619–0.784], P < 0.001). More importantly, incorporating PCT with other risk factors into the prediction model significantly increased the AUC for prediction of DIC induced by sepsis shock (0.801vs 0.706; P = 0.012). Conclusions Our study suggests that PCT levels on admission is significantly and independently associated with DIC development subsequently with septic shock, combining PCT levels with other risk factors could significantly improve the prediction of DIC induced by sepsis shock.

Download Full-text