Response patterns of routinely measured inflammatory and coagulatory parameters in sepsis

PeerJ

article

Mirjam Bachler¹  Tobias Hell²  Lukas Schausberger³  Christine Schlömmer³  Volker Schäfer⁴  Marlies Liebensteiner³  Katharina Schäffler³  Bettina Schenk³  Dietmar Fries³  Petra Innerhofer⁴  Christian Niederwanger⁵ 

[1] University for Health Sciences, Medical Informatics and Technology, Institute for Sports Medicine, Alpine Medicine and Health Tourism;Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck;Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck;Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck;Department of Pediatrics, Pediatrics I, Medical University of Innsbruck

关键词: Fibrinogen;    C-reactive protein;    Inflammation;    Coagulation;    Platelets;    Sepsis;    Survival;    Liver failure;    Bilirubin;    Mortality;   

DOI  :  10.7717/peerj.7147

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundSepsis is characterized by a pro-inflammatory and pro-coagulatory shift which can induce life-threatening complications. Close monitoring and risk stratification of sepsis patients is crucial for proper treatment and consequently patient outcome. Therefore, this study focuses on the response patterns of inflammatory and coagulatory parameters used in clinical routines to estimate the course of sepsis.MethodsA total of 1,110 patients diagnosed with sepsis were retrospectively analyzed to identify response patterns for risk stratification of routine parameters measured at the peak level of C-reactive protein. Cluster analysis was used and the differences in the patient characteristics and 28-day survival were assessed. Cox proportional hazards regression model for survival stratified by the clusters was performed.ResultsThe analyses revealed the parameters to have five distinct response patterns. These clusters reflect the etiology as well as the course of sepsis associated with different mortalities. Here, impairment of the liver plays a crucial role in the ability to appropriately respond to sepsis. Of the routinely measured parameters, C-reactive protein and antithrombin seem to be unspecific for stratification of septic patients. Adjusted for the individual clusters, survival was associated with an increase in fibrinogen (p = 0.0042), platelets (p = 0.0003) and PT (p = 0.001) as well as a decrease in leukocytes (p = 0.034).ConclusionsThis study reveals that patients have distinct response patterns of inflammatory and coagulatory parameters depending on disease etiology. These patterns are associated with different mortalities although the patients have similar levels of C-reactive protein. Independently of the type of response, good coagulatory capacity seems to be crucial for patient survival.

【 授权许可】

CC BY