Can Coagulation System Disorders and Cytokine and Inflammatory Marker Levels Predict the Temporary Clinical Deterioration or Improvement of Septic Patients on ICU Admission?

Abstract

Although coagulation disorders and immune/inflammatory response have been associated with the final outcome of patients with sepsis, their link with thetemporaryclinical deterioration or improvement of patients is unknown. We aimed to investigate this link. We prospectively included consecutive patients admitted to the intensive care unit (ICU) with a suspected diagnosis of infection and evaluated within the first 24 h from admission. Blood levels of many cytokines and inflammatory and coagulation factors were measured and their predictive value was assessed by calculating the Area Under the Receiver Operating Characteristic (AUROC) curves. Patients (n = 102) were allocated in five groups, i.e., sepsis (n = 14), severe sepsis (n = 17), septic shock (n = 28), Systemic Inflammatory Response Syndrome (SIRS) without infection (n = 17), and trauma/surgery without SIRS or infection (n = 26). In septic shock, coagulation factors FVII and FIX and Protein C had AUROCs 0.67-0.78. In severe sepsis, Antithrombin III, Protein C, C-reactive protein, Procalcitonin and Thrombopoietin had AUROCs 0.73-0.75. In sepsis, Tumor Necrosis Factor a, and Interleukins 1β and 10 had AUROCs 0.66-0.72. In patients admitted to the ICU with a suspected diagnosis of infection, coagulation factors and inhibitors, as well as cytokine and inflammatory marker levels, have substantial predictive value in distinct groups of septic patients.

Keywords: antithrombin III; coagulation; coagulation inhibitors; cytokines; procalcitonin; protein C; sepsis; septicshock; thrombopoietin.

Figure 1

Receiver operating characteristic curves for Inteleukin 10 (a), Antithrombin III (ATIII) (b) and Protein C (c) in sepsis, severe sepsis and septic shock, respectively; the areas under the curves, indicating the predictive value of each variable in the sense of patient temporary clinical deterioration or improvement, were 0.72 ([95% confidenceinterval] 0.51–0.87), 0.74 (0.62−0.86) and 0.78 (0.60–0.95), respectively.

Figure 1

Receiver operating characteristic curves for Inteleukin 10 (a), Antithrombin III (ATIII) (b) and Protein C (c) in sepsis, severe sepsis and septic shock, respectively; the areas under the curves, indicating the predictive value of each variable in the sense of patient temporary clinical deterioration or improvement, were 0.72 ([95% confidenceinterval] 0.51–0.87), 0.74 (0.62−0.86) and 0.78 (0.60–0.95), respectively.