Decreasing Plasma Fibrinogen Levels in the Intensive Care Unit Are Associated with High Mortality Rates In Patients With Sepsis-Induced Coagulopathy

Abstract

Plasma fibrinogen levels increase in response to infection, but they could also decrease due to degradation as in severe coagulopathy. We evaluated 60 septic patients with their CRP levels over 5.00 mg/dL. The patients were classified into three groups based on the ratio of the maximum or minimum fibrinogen concentration within day 3 to the initial concentration on day 0: down-, flat, and uptrend groups (n = 15, 30, and 15, respectively). Both down- and flat trend groups showed reduced inflammatory markers on day 3, and the degree of platelet loss (10³/μL) and the mortality rate (%) were more remarkable in the downtrend group ( - 108 vs - 42 [p = 0.026] and 46.7 vs 10.0 [p = 0.027]). On day 0, in total 12 and 9 patients were diagnosed with non-overt DIC in the down- and uptrend groups, of which 5 (41.7%) and 1 (11.1%) died within 28 days after admission. In conclusion, decreasing fibrinogen levels in the ICU are associated with high mortality in patients with sepsis followed by decreasing platelet counts, even when they are diagnosed with non-overt DIC.

Keywords: SOFA score; fibrinogen; mortality; sepsis; sepsis-induced coagulopathy.

Figure 1.

Time-course changes of ISTH DIC score, WBC count, platelet count, CRP level, fibrinogen level, D-dimer level, and PT-INR from the ICU arrival to day 3. Data were compared between the arrival and day 3, and presented as median and as first and third quantiles. *: 0.01 < P < 0.05, **: 0.001 < P < 0.01, and ***: P < 0.001.

Figure 2.

Degree of changes in ISTH DIC score, WBC count, platelet count, CRP level, fibrinogen level, D-dimer level, and PT-INR from ICU arrival to day 3. Data were compared between the three fibrinogen trend groups, and presented as median and as first and third quantiles. *: 0.01 < P < 0.05, **: 0.001 < P < 0.01, and ***: P < 0.001.

Figure 3.

Kaplan-Meier 28-day survival curves for the three trend groups. The global p-value for the three group comparison is 0.020; the p-value of each pair-wise comparison shows significant differences between the down- and flat trend groups.