The pathophysiology, diagnosis, and management of sepsis-associated disseminated intravascular coagulation

Journal of Intensive Care

Review

Jerrold H. Levy¹  Toshiaki Iba²  Jean Marie Connors³  Julie Helms⁴ 

[1] Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, NC, USA;Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, 113-8421, Tokyo, Japan;Hematology Division Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;Université de Strasbourg (UNISTRA), Faculté de 1Médecine, Hôpitaux Universitaires de Strasbourg, Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, 1, place de l’Hôpital, 67091, Strasbourg Cedex, France;INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), FMTS, Strasbourg, France;

关键词: Sepsis;    Disseminated intravascular coagulation;    Coagulopathy;    Endothelial cell;    Antithrombin;    Thrombomodulin;   

DOI  :  10.1186/s40560-023-00672-5

 received in 2023-01-05, accepted in 2023-05-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe International Society on Thrombosis and Haemostasis (ISTH) released overt disseminated intravascular coagulation (DIC) diagnostic criteria in 2001. Since then, DIC has been understood as the end-stage consumptive coagulopathy and not the therapeutic target. However, DIC is not merely a decompensated coagulation disorder, but also includes early stages with systemic activation in coagulation. Thus, the ISTH has recently released sepsis-induced coagulopathy (SIC) criteria that can diagnose compensated-phase of coagulopathy with readily available biomarkers.Main bodyDIC is a laboratory-based diagnosis due to various critical conditions, although sepsis is the most common underlying disease. The pathophysiology of sepsis-associated DIC is multifactorial, and in addition to coagulation activation with suppressed fibrinolysis, multiple inflammatory responses are initiated by activated leukocytes, platelets, and vascular endothelial cells as part of thromboinflammation. Although overt DIC diagnostic criteria were established by ISTH to diagnose the advanced stage of DIC, additional criteria that can detect an earlier stage of DIC were needed for potential therapeutic considerations. Accordingly, the ISTH introduced SIC criteria in 2019 that are easy to use and require only platelet count, prothrombin time-international normalized ratio, and Sequential Organ Failure Assessment Score. SIC score can be used to evaluate disease severity and determine the timing of potential therapeutic interventions. One of the major disadvantages in treating sepsis-associated DIC is the lack of availability of specific therapeutic approaches beyond treating the underlying infection. Clinical trials to date have failed because included patients who were not coagulopathic. Nevertheless, in addition to infection control, anticoagulant therapy will be the choice for sepsis-associated DIC. Therefore, the efficacy of heparin, antithrombin, and recombinant thrombomodulin has to be proven in future clinical studies.ConclusionIt is necessary to develop a novel therapeutic strategy against sepsis-associated DIC and improve the outcomes. Consequently, we recommend screening and monitoring DIC using SIC scoring system.

【 授权许可】

CC BY   
© The Author(s) 2023

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