Sepsis

 

Recently, the International Society of Thrombosis and Haemostasis (ISTH) has defined a sepsis-induced coagulopathy (SIC) as “infection-induced organ dysfunction and coagulopathy” (Iba et al 2019). Although sepsis is one of the main triggers of disseminated intravascular coagulation (DIC), there is recognition that sepsis can result in a coagulopathy that precedes overt DIC. Sepsis-induced coagulopathy is characterized by suppression of fibrinolysis secondary to high concentrations of plasminogen activator inhibitor-1 (PAI-1), which predisposes the patient to thrombosis. Thrombosis induces end-organ dysfunction via ischemic injury. The major goal of this new definition is to use more limited and less costly diagnostic tests to diagnose SIC and help standardize criteria for studies aimed at evaluating efficacy of various therapeutic agents in SIC and sepsis-induced DIC. The proposed scoring scheme is simpler than that for overt DIC, being based on degree of thrombocytopenia, degree of prolongation of the prothrombin time, and sequential organ failure assessment (SOFA) score. It does not include fibrinogen or markers of fibrinolysis (D-dimer, fibrin[ogen] degradation products) (Iba et al 2019). The SOFA score is based on activation of coagulation (thrombocytopenia) and organ dysfunction – lungs (hypoxemia based on partial pressure of oxygen, oxygen saturation, fraction of inspired oxygen), brain (Glasgow coma score, which assesses consciousness, typically in patients with traumatic brain injury), liver (increased total bilirubin concentration), heart (hypotension), and kidney (high creatinine concentrations) (Jones et al 2009). Measurement of the SOFA score at admission and then sequentially is recommended to see progression or initiation of organ injury. Proposed treatments for SIC are heparin-based anticoagulants and inhibitors of thrombosis, specifically antithrombin and thrombomodulin (Iba et al 2019). It is unlikely that SIC criteria will be adopted in veterinary medicine anytime soon and the proposed scoring system requires future validation through well-designed clinical trials. 

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