title: The imbalance between coagulation and fibrinolysis is related to the severity of the illness and the prognosis in sepsis.
abstract: OBJECTIVE
  The coagulation and fibrinolytic system appears to be activated by the septic process independently, leading to the syndrome of disseminated intravascular coagulation (DIC). In this study, we investigated the changes within the hemostatic system related to the severity of the illness and the prognosis in patients with sepsis.
  
  
  METHODS
  Plasma thrombin-antithrombin III (TAT) and plasmin-alpha 2-antiplasmin (PAP) complexes were measured using ELISA methods in 32 patients with sepsis and 20 controls and were analyzed according to the APACHE III scores and survival of the patients.
  
  
  RESULTS
  Plasma TAT and PAP in patients with sepsis were significantly higher than controls. Nonsurvivors showed greater levels of TAT (21.7 +/- 22.3 ng/mL) and lower levels of PAP (628.4 +/- 378.1 ng/mL) than survivors (TAT: 11.1 +/- 11.2 ng/mL; PAP: 857.1 +/- 364.1 ng/mL). The imbalance between coagulation and fibrinolysis described as TAT/PAP ratio was closely related with APACHE III scores in patients with sepsis (r = 0.47) and the TAT/PAP ratio in nonsurvivors was significantly higher compared with survivors (34.4 +/- 21.4 vs. 14.4 +/- 13.8).
  
  
  CONCLUSIONS
  In sepsis, both coagulation and the fibrinolysis system are activated and the imbalance between coagulation and fibrinolysis predisposes to the hypercoagulation state and is closely related to the severity of the disease and the prognosis.
authors.affiliation: Department of Pulmonology, Ajou University School of Medicine, Suwon, Korea.
authors.forename: K J
authors.initials: KJ
authors.lastname: Park
authors.forename: H J
authors.initials: HJ
authors.lastname: Kim
authors.forename: S C
authors.initials: SC
authors.lastname: Hwang
authors.forename: S M
authors.initials: SM
authors.lastname: Lee
authors.forename: Y H
authors.initials: YH
authors.lastname: Lee
authors.forename: M H
authors.initials: MH
authors.lastname: Hahn
authors.forename: S K
authors.initials: SK
authors.lastname: Kim
authors.forename: W Y
authors.initials: WY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism; D001777:Blood Coagulation; D016022:Case-Control Studies; D005260:Female; D005341:Fibrinolysin / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018805:Sepsis / Q000097:blood*; D013917:Thrombin / Q000378:metabolism; D000979:alpha-2-Antiplasmin / Q000378:metabolism
chemical_list: D000979:alpha-2-Antiplasmin; D000990:Antithrombin III; D013917:Thrombin; D005341:Fibrinolysin