Coagulation disorders in patients with cirrhosis and severe sepsis.
BACKGROUND
In patients with cirrhosis, severe sepsis may stimulate the extrinsic coagulation pathway resulting in thrombin generation and fibrin formation.


OBJECTIVE
To compare 23 patients with severe sepsis to 13 infected patients without severe sepsis and 18 patients without infection.


METHODS
Zymogen forms of clotting factors involved in the extrinsic pathway (i.e., factors VII + X, V, prothrombin), and the presence of soluble fibrin were assessed.


RESULTS
Zymogen forms of clotting factors were significantly lower, while Child-Pugh score and the proportion of patients with soluble fibrin were higher in the severe-sepsis group than in the other groups. Decreased zymogen levels were independently correlated with an elevated Child-Pugh score and the presence of severe sepsis. In the severe-sepsis group, after adjustment for the severity of cirrhosis, decreased zymogen levels were associated with significant increases in the relative risk ratios of in-hospital death.


CONCLUSIONS
Cirrhotic patients with severe sepsis have decreased blood levels of zymogen forms of factors VII+X, V, and prothrombin, which may be due not only to the severity of cirrhosis but also, at least in part, to the consumption of these zymogens by the extrinsic coagulation pathway.
Plessier
Aurélie
A
Laboratoire d'Hémodynamique Splanchnique et de Biologie Vasculaire, INSERM U-481, et Service d'Hepatologie, Hôpital Beaujon, Clichy, France.
Denninger
Marie-Hélène
MH
Consigny
Yann
Y
Pessione
Fabienne
F
Francoz
Claire
C
Durand
François
F
Francque
Sven
S
Bezeaud
Annie
A
Chauvelot-Moachon
Laurence
L
Lebrec
Didier
D
Valla
Dominique-Charles
DC
Moreau
Richard
R
D001778:Blood Coagulation Disorders / Q000150:complications* / Q000175:diagnosis; D001780:Blood Coagulation Tests; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D018805:Sepsis / Q000150:complications*; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications