Korean J Intern Med.  1999 Jul;14(2):72-77.

The imbalance between coagulation and fibrinolysis is related to the severity of the illness and the prognosis in sepsis

• Park KJ
• Kim HJ
• Hwang SC
• Lee SM
• Lee YH
• Hahn MH
• Kim SK
• Lee WY

Abstract

OBJECTIVES
The coagulation and fibrinolytic system appears to be activated by the septic process independently, leading to the syndrome of disseminated intravascular coagulation (DIC). In this study, we investigated the changes within the hemostatic system related to the severity of the illness and the prognosis in patients with sepsis. METHODS: Plasma thrombin-antithrombin III (TAT) and plasmin-alpha 2-antiplasmin (PAP) complexes were measured using ELISA methods in 32 patients with sepsis and 20 controls and were analyzed according to the APACHE III scores and survival of the patients. RESULTS: Plasma TAT and PAP in patients with sepsis were significantly higher than controls. Nonsurvivors showed greater levels of TAT (21.7 +/- 22.3 ng/mL) and lower levels of PAP (628.4 +/- 378.1 ng/mL) than survivors (TAT: 11.1 +/- 11.2 ng/mL; PAP: 857.1 +/- 364.1 ng/mL). The imbalance between coagulation and fibrinolysis described as TAT/PAP ratio was closely related with APACHE III scores in patients with sepsis (r = 0.47) and the TAT/PAP ratio in nonsurvivors was significantly higher compared with survivors (34.4 +/- 21.4 vs. 14.4 +/- 13.8). CONCLUSION: In sepsis, both coagulation and the fibrinolysis system are activated and the imbalance between coagulation and fibrinolysis predisposes to the hypercoagulation state and is closely related to the severity of the disease and the prognosis.

Keyword

Sepsis; Coagulation; Fibrinolysis; Thrombin-antithrombin III complex (TAT); Plasmin-alpha2-antiplasmin complex(PAP)

MeSH Terms

Adult
Aged
Antiplasmin/metabolism
Antithrombin III/metabolism
Blood Coagulation*
Case-Control Studies
Female
Fibrinolysis*
Human
Male
Middle Age
Plasmin/metabolism
Prognosis
Sepsis/blood*
Thrombin/metabolism