Hemostasis biomarkers and risk of sepsis: the REGARDS cohort

Abstract

Summary Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case–control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01–1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03–2.07) and FXI levels ([OR] 1.52, 95% [CI] 1.04–2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI levels are associated with future episodes of sepsis. Hemostasis biomarkers may provide targets for sepsis mitigation or prevention.

Circulating Vitronectin Predicts Liver Injury and Mortality in Children With Sepsis: A Prospective Observational Study

“… 3 – 6 The cross talk between thrombosis and inflammation supports the concept of a thrombo-inflammatory state correlates with septic severity and prognosis, 7 and thrombus biomarkers such as D-dimer, fibrinogen (Fib), and platelet count are associated with the short-term adverse outcomes of patients with sepsis. 7 – 9 However, it remains unclear whether specific indicators for thrombosis would be helpful in identifying patients with sepsis who are at an increased risk of death in the early onset of the condition, which is critical for risk identification and treatment decisions.…”

Risk factors for the development of sepsis in patients with cirrhosis in intensive care units

“…27 As an acute-phase reactant, fibrinogen is elevated in patients with infection and/or inflammation, and increased baseline fibrinogen levels are associated with an increased risk of sepsis. 28 As can be seen from the nomogram, SBP and vasopressor use are weighted more heavily, and the risk of sepsis in patients with cirrhosis gradually increases with the in SBP and the use of vasopressor. It suggests that the patient has experienced a decrease in blood pressure and needs pharmacological treatment to improve vascular function and microcirculatory perfusion.…”

“…Fibrinogen is a glycoprotein produced by the liver and circulating in the blood, which is used to diagnose coagulopathy in critically ill patients 27 . As an acute‐phase reactant, fibrinogen is elevated in patients with infection and/or inflammation, and increased baseline fibrinogen levels are associated with an increased risk of sepsis 28 . As can be seen from the nomogram, SBP and vasopressor use are weighted more heavily, and the risk of sepsis in patients with cirrhosis gradually increases with the decrease in SBP and the use of vasopressor.…”

Pharmacokinetics of vancomycin in patients with different renal function levels

“…Increased heart output and hyperkinetic circulation increase perfusion of kidneys, elevating the glomerular filtration rate and bringing a greater number of drug molecules to the tubule lumen; if a molecule of an antibiotic is hydrophilic, it could not be reabsorbed and will be excreted in the urine. Therefore, it is not surprising that plasma levels of fibrinogen, which is elevated in infection [ 18 ], are associated with clearance of vancomycin (which is a hydrophilic drug)—i.e., increased fibrinogen levels and increased vancomycin clearance go together. Indeed, the mean serum level of C-reactive protein, another marker of sepsis, was above 100 mg/l in patients with normal renal function (104.91±85.88 [SE] mg/l).…”