Relationship between protein C and antithrombin III deficiencies in sepsis without disseminated intravascular coagulation status

Background

Recently, a reciprocal relationship has been known between anti-inflammation and anticoagulation responses to infection. In our previous studies, protein C (PC) deficiency and antithrombin III (AT III) deficiency have been shown in septic patients. Moreover, these AT III deficiencies in sepsis did not relate to their disseminated intravascular coagulation (DIC) status. We hypothesize that PC activity relates to AT III activity in septic patients without DIC status.

Materials

Fifty ICU patients were included in this study and divided into three groups by primary diagnosis on admission; trauma patients, nonseptic patients, and septic patients. The patients who had already DIC on admission were excluded.

Methods

Serum PC activity (%) (Diagnostica Stago^®, Tokyo, Japan) and serum AT III activity (%) (Sysmex^®, Kobe, Japan) were measured on admission. PC and AT III activities were compared between three groups. Values are expressed as the median. Data were analyzed by the Kruskal–Wallis test and the Mann–Whitney U test. Pearson's correlation coefficient was used for correlation. P < 0.05 was considered statistically significant.

Results

There were 23 trauma patients, 12 nonseptic patients and 15 septic patients. PC activity was significantly lower in septic patients than in trauma or in nonseptic patients (54.6 versus 85.6, 94.0% respectively, P = 0.0006). AT III activity was also lower in septic patients than in other groups (54.2 versus 94.4, 81.2% respectively, P < 0.001). There were correlations of PC activity with AT III activity in trauma patients (r = 0.76, P < 0.0001) and in non-septic patients (r = 0.61, P = 0.048). Especially, in septic patients, PC activity had significant correlation with AT III activity (r = 0.91, P < 0.0001).

Conclusion

Both PC deficiency and AT III deficiency had already been shown in septic patients on admission to the ICU, but nevertheless no DIC status. The relationship between PC activity and AT III activity was found in all patients and there could be a definite correlation in septic patients.