Coagulopathy and sepsis: Pathophysiology, clinical manifestations and treatment

Giustozzi, Michela; Ehrlinder, Hanne; Bongiovanni, Dario; Borovac, Josip Anđelo; Guerreiro, Rui Azevedo; Papakonstantinou, Panteleimon E.; Parker, William A.

doi:10.1016/j.blre.2021.100864

Cited by 66 publications

(60 citation statements)

References 108 publications

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“…The patients accompanied with AF were older than that of patients without AF (70, 63-76 vs. 58, 48-69; P < 0.001). Furthermore, stroke (0.76 vs. 3.30%; P < 0.001), CHF (16.23 vs. 41.43%; P < 0.001), hypertension (43.90 vs. 56.48%; P < 0.001), diabetes (24.47 vs. 35.32%; P < 0.001), ECI (11,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) vs. 17.12-22; P < 0.001), APS III (49, 37-63 vs. 53, 42-67; P < 0.001), INR (1.3, 1.2-1.7 vs. 1.5, 1.2-2.2; P < 0.001), and APTT (32.7, 27.7-43.9, vs. 34.6, 29-46.1; P < 0.001) were significantly different in patients between the AF and non-AF groups. Among septic patients, the AF group had higher in-hospital mortality and 90-day mortality (19.71 vs. 13.79%, P < 0.001; 59.21 vs. 56.04%, P = 0.001).…”

Section: Demographic and Baseline Characteristicsmentioning

confidence: 99%

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Early Coagulation Disorder Is Associated With an Increased Risk of Atrial Fibrillation in Septic Patients

Long

Tong

Miao

et al. 2021

Front. Cardiovasc. Med.

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Background: Atrial fibrillation (AF) and coagulation disorder, two common complications of sepsis, are associated with the mortality. However, the relationship between early coagulation disorder and AF in sepsis remains elusive. This study aimed to evaluate the interaction between AF and early coagulation disorder on mortality.Methods: In this retrospective study, all data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Septic patients with coagulation tests during the first 24 h after admission to intensive care units (ICUs) meeting study criteria were included in the analysis. Early coagulation disorder is defined by abnormalities in platelet count (PLT), international normalized ratio (INR) and activated partial thromboplastin time (APTT) within the first 24 h after admission, whose score was defined with reference to sepsis-induced coagulopathy (SIC) and coagulopathy. Patients meeting study criteria were divided into AF and non-AF groups.Results: In total, 7,528 septic patients were enrolled, including 1,243 (16.51%) with AF and 5,112 (67.91%) with early coagulation disorder. Compared with patients in the non-AF group, patients in the AF group had higher levels of INR and APTT (P < 0.001). Multivariable logistic regression analyses showed that stroke, early coagulation disorder, age, gender, congestive heart failure (CHF), chronic pulmonary disease, renal failure, and chronic liver disease were independent risk factors for AF. In addition, AF was related to in-hospital mortality and 90-day mortality. In the subgroup analysis stratified by the scores of early coagulation disorder, AF was associated with an increased risk of 90-day mortality when the scores of early coagulation disorder were 1 or 2 and 3 or 4.Conclusion: In sepsis, coagulation disorder within the first 24 h after admission to the ICUs is an independent risk factor for AF. The effect of AF on 90-day mortality varies with the severity of early coagulation disorder.

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Section: Demographic and Baseline Characteristicsmentioning

confidence: 99%

“…Coagulation dysfunction, including SIC and DIC, are common complications in sepsis ( 7 ). After being triggered by an acute systemic inflammatory response of sepsis, coagulation initiates and induces extensive crosstalk with inflammation and immunity to promote SIC and DIC ( 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Early Coagulation Disorder Is Associated With an Increased Risk of Atrial Fibrillation in Septic Patients

Long

Tong

Miao

et al. 2021

Front. Cardiovasc. Med.

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“…Although sepsis is one of the most common causes of thrombocytopenia in critically ill patients, several other causes can mimic sepsis-related thrombocytopenia, such as myelodysplastic syndrome and aplastic anemia, as well as drugs, such as thiazide or chemotherapics, which inhibit platelet production [97].…”

Section: Plateletsmentioning

confidence: 99%

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

et al. 2021

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Sepsis represents an important global health burden due to its high mortality and morbidity. The rapid detection of sepsis is crucial in order to prevent adverse outcomes and reduce mortality. However, the diagnosis of sepsis is still challenging and many efforts have been made to identify reliable biomarkers. Unfortunately, many investigated biomarkers have several limitations that do not support their introduction in clinical practice, such as moderate diagnostic and prognostic accuracy, long turn-around time, and high-costs. Complete blood count represents instead a precious test that provides a wealth of information on individual health status. It can guide clinicians to early-identify patients at high risk of developing sepsis and to predict adverse outcomes. It has several advantages, being cheap, easy-to-perform, and available in all wards, from the emergency department to the intensive care unit. Noteworthy, it represents a first-level test and an alteration of its parameters must always be considered within the clinical context, and the eventual suspect of sepsis must be confirmed by more specific investigations. In this review, we describe the usefulness of basic and new complete blood count parameters as diagnostic and prognostic biomarkers of sepsis.

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“…After the vascular wall is damaged, vascular endothelial cells, neutrophils, monocytes and platelets can express and release tissue factor, and then activate the coagulation system [39]. In addition, the release of inflammatory mediators after sepsis and the direct binding of activated immune cells to platelets activate platelets, resulting in abnormal coagulation function [40]. Tian et al demonstrated that the surface of BDEV carries tissue factor, and BDEVs promoted the expression of PS on the platelet surface after binding with platelets.…”

Section: Discussionmentioning

confidence: 99%

Brain-derived extracellular vesicles mediated coagulopathy, inflammation and apoptosis after sepsis

Lin¹,

Chen²,

Qi³

et al. 2021

Thrombosis Research

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The activation of coagulation, inflammation and other pathways is the basic response of the host to infection in sepsis, but this response also causes damage to the host. Brain-derived extracellular vesicles (BDEVs) have been reported to cause a hypercoagulable state that can rapidly develop into consumptive coagulopathy, which is consistent with the pathophysiological process of sepsis-induced coagulopathy. However, the role of BDEVs in sepsis-induced coagulopathy remains unclear. Materials and methods: Male Sprague-Dawley (SD) rats were used for sepsis modeling using cecal ligation puncture (CLP). Flow cytometry was used to measure the levels of circulating BDEVs. Enzyme-linked immunosorbent assay (ELISA) was used to measure the serum levels of plasminogen activator inhibitor type 1 (PAI-1), thrombin-antithrombin (TAT), D-dimer, fibrinogen(Fib), tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β and IL-6. Nanoparticle tracking analysis (NTA) and Transmission electron microscopy (TEM) were used to identify BDEVs. Western blot (WB) was used to determine the expression of glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), bax, bcl-2 and cleaved caspase-3. Hematoxylin-eosin (HE) and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining were performed to detect tissue injury. Survival was monitored over the course of 168 h. Results: We found that a large number of BDEVs were released into the circulating blood in septic rats. Moreover, we observed that BDEVs injection activated the systemic coagulation reaction and induced lung, liver and kidney inflammation and apoptosis(P < .05). Compared with BDEVs from sham-operated rats, BDEVs from septic rats exacerbated this process(P < .05). Conclusions: This finding suggests that inhibiting BDEVs may yield therapeutic benefits in the treatment of sepsisinduced coagulopathy.

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Coagulopathy and sepsis: Pathophysiology, clinical manifestations and treatment

Cited by 66 publications

References 108 publications

Early Coagulation Disorder Is Associated With an Increased Risk of Atrial Fibrillation in Septic Patients

Early Coagulation Disorder Is Associated With an Increased Risk of Atrial Fibrillation in Septic Patients

The Value of a Complete Blood Count (CBC) for Sepsis Diagnosis and Prognosis

Brain-derived extracellular vesicles mediated coagulopathy, inflammation and apoptosis after sepsis

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