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. 2016 Nov;14(11):2169-2176.
doi: 10.1111/jth.13446. Epub 2016 Sep 23.

Hemostasis biomarkers and risk of sepsis: the REGARDS cohort

J X Moore  1   2 , N A Zakai  3 , M Mahalingam  4 , R L Griffin  3 , M R Irvin  3 , M M Safford  5 , J W Baddley  6 , H E Wang  1
Affiliations

Hemostasis biomarkers and risk of sepsis: the REGARDS cohort

J X Moore et al. J Thromb Haemost. 2016 Nov.

Abstract

Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention.

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.

Keywords: epidemiology; factor IX; factor VIII; factor XI; fibrinogen; sepsis.

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Conflict of interest statement

Disclosure of Conflict of Interests

M. M. Safford reports the following potential conflicts of interest: Amgen – salary support to study patterns of statin use in Medicare and other large databases; diaDexus – salary support for a research grant on lipids and CHD outcomes; diaDexus – consulting to help with an FDA application; and NIH, AHRQ – salary support for research grants. The other authors state that they have no conflict of interest.

Figures

Fig 1
Fig 1
Flowchart of REGARDS participants included in the analysis.
See this image and copyright information in PMC

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