Fibrinolysis in early recognition of sepsis in patients with severe trauma

Background

Early diagnosis of sepsis improves outcomes for trauma patients. The aim of this study was to detect additional markers that help to recognize sepsis before manifestation in patients with severe multiple trauma and blood loss. It is known that depletion of fibrinolysis promotes microvascular alterations after massive blood loss. During inflammation, C-reactive protein may inhibit fibrinolysis by inducing plasminogen activator inhibitor 1. These alterations are correlated with an increased risk of multiple organ failure and death. In accordance with the above-mentioned purpose, we investigated fibrinolysis at the early post-traumatic period in patients with and without sepsis.

Materials and methods

We examined a database of 58 intensive care unit patients with trauma and shock, Acute Physiology and Chronic Health Evaluation II score (first day in intensive care unit) of 27.4 ± 0.5. Group 1 consisted of 23 patients who developed sepsis (day after admission, when severe sepsis or septic shock manifested, was 6.1 ± 0.28). Group 2 consisted of 35 patients without sepsis within the early post-traumatic period (1–14 days after injury). The plasma fibrinolytic potential was evaluated by the euglobulin lysis time, determined by a semiautomatic method.

Results

Data are presented as the mean ± median (Table 1). It was established that fibrinolytic potential was significantly lower in patients with sepsis versus patients without sepsis since the fifth day after admission. At the same time, for white blood cells, a significant difference was observed just after the seventh day following admission. Platelets did not differ between groups.

Conclusion

Plasma fibrinolytic potential is closely related to inflammation and may be used as a marker of sepsis. Moreover, plasma fibrinolytic potential may be a useful test for early identification of the high-risk sepsis patient.

Table 1 Fibrinolysis, white blood cells and platelets in groups during the early post-traumatic period