title: Hemostasis biomarkers and risk of sepsis: the REGARDS cohort.
abstract: Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention.
  
  
  
  Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case-control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01-1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03-2.07) and FXI levels ([OR]1.52, 95% [CI] 1.04-2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI levels are associated with future episodes of sepsis. Hemostasis biomarkers may provide targets for sepsis mitigation or prevention.
authors: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.|Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: J X
authors: JX
authors: Moore
authors: Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA.
authors: N A
authors: NA
authors: Zakai
authors: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: M
authors: M
authors: Mahalingam
authors: Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA.
authors: R L
authors: RL
authors: Griffin
authors: Departments of Medicine and Pathology, University of Vermont College of Medicine, Colchester Research Facility, Colchester, VT, USA.
authors: M R
authors: MR
authors: Irvin
authors: Department of Medicine, Weill-Cornell Medical Center, New York, NY, USA.
authors: M M
authors: MM
authors: Safford
authors: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: J W
authors: JW
authors: Baddley
authors: Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors: H E
authors: HE
authors: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D005006:Ethnicity; D005164:Factor IX / Q000378:metabolism; D005172:Factor XI / Q000378:metabolism; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D006487:Hemostasis; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012044:Regression Analysis; D018805:Sepsis / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology*; D014481:United States
chemical_list: D015415:Biomarkers; D005164:Factor IX; D005340:Fibrinogen; D005172:Factor XI
keywords: epidemiology; factor IX; factor VIII; factor XI; fibrinogen; sepsis