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Man C, An Y, Wang GX, Mao EQ, Ma L. Recent Advances in Pathogenesis and Anticoagulation Treatment of Sepsis-Induced Coagulopathy. J Inflamm Res 2025; 18:737-750. [PMID: 39845020 PMCID: PMC11752821 DOI: 10.2147/jir.s495223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 12/31/2024] [Indexed: 01/24/2025] Open
Abstract
Coagulopathy in sepsis is common and is associated with high mortality. Although immunothrombosis is necessary for infection control, excessive thrombus formation can trigger a systemic thrombo-inflammatory response. Immunothrombosis plays a core role in sepsis-induced coagulopathy, and research has revealed a complex interplay between inflammation and coagulation. Different mechanisms underlying sepsis-related coagulopathy are discussed, including factors contributing to the imbalance of pro- and anticoagulation relevant to endothelial cells. The potential therapeutic implications of anticoagulants on these mechanisms are discussed. This review contributes to our understanding of the pathogenesis of coagulopathy in patients with sepsis. Recent studies suggest that endothelial cells play an important role in immunoregulation and hemostasis. Meanwhile, the non-anticoagulation effects of anticoagulants, especially heparin, which act in the pathogenesis of coagulopathy in septic patients, have been partially revealed. We believe that further insights into the pathogenesis of sepsis-induced coagulopathy will help physicians evaluate patient conditions effectively, leading to advanced early recognition and better decision-making in the treatment of sepsis.
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Affiliation(s)
- Chit Man
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Yuan An
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Guo-Xin Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - En-Qiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
| | - Li Ma
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People’s Republic of China
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Chen P, Ge Y, Sheng H, Sun W, Wang J, Ma L, Mao E. The role of early changes in routine coagulation tests in predicting the occurrence and prognosis of sepsis. World J Emerg Med 2025; 16:136-143. [PMID: 40135212 PMCID: PMC11930565 DOI: 10.5847/wjem.j.1920-8642.2025.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/15/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND This study aimed to explore the importance of routine coagulation tests for the early detection of sepsis and to quickly identify patients at a high risk of mortality. METHODS This retrospective single-center study collected data from patients meeting the clinical criteria for systemic inflammatory response syndrome (SIRS) with a confirmed infection source. Patients with coagulation disorders or on medications affecting coagulation were excluded. Patients were divided into sepsis and non-sepsis groups based on a Sequential Organ Failure Assessment (SOFA) score of ≥2. Univariate and multivariate logistic regression identified indicators from routine coagulation tests that predict sepsis. Prognostic roles of coagulation indicators were analyzed within the sepsis group. RESULTS A total of 512 patients were included, with 396 in the sepsis group and 116 in the non-sepsis group. The predictive factors in the sepsis prediction model encompass fibrin degradation products (FDP), D-dimer, lactate, procalcitonin (PCT) levels and the utilization of mechanical ventilation. Early elevation of FDP and D-dimer levels predicted sepsis onset. The model exhibited an area under the curve (AUC) of 0.943 (95% CI: 0.923-0.963). In the sepsis group, Cox regression analysis revealed an association between prothrombin time (PT) and in-hospital mortality. CONCLUSION Abnormal high FDP and D-dimer levels in the early stages of sepsis provide a supplementary method for predicting sepsis. As the disease progresses, prolonged PT in the early stages of sepsis suggests a poor prognosis.
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Affiliation(s)
- Peili Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yan Ge
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Huiqiu Sheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Wenwu Sun
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jiahui Wang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Li Ma
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Claesen K, Sim Y, Bracke A, De bruyn M, De Hert E, Vliegen G, Hotterbeekx A, Vujkovic A, van Petersen L, De Winter FHR, Brosius I, Theunissen C, van Ierssel S, van Frankenhuijsen M, Vlieghe E, Vercauteren K, Kumar-Singh S, De Meester I, Hendriks D. Activation of the Carboxypeptidase U (CPU, TAFIa, CPB2) System in Patients with SARS-CoV-2 Infection Could Contribute to COVID-19 Hypofibrinolytic State and Disease Severity Prognosis. J Clin Med 2022; 11:jcm11061494. [PMID: 35329820 PMCID: PMC8954233 DOI: 10.3390/jcm11061494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 01/27/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a viral lower respiratory tract infection caused by the highly transmissible and pathogenic SARS-CoV-2 (severe acute respiratory-syndrome coronavirus-2). Besides respiratory failure, systemic thromboembolic complications are frequent in COVID-19 patients and suggested to be the result of a dysregulation of the hemostatic balance. Although several markers of coagulation and fibrinolysis have been studied extensively, little is known about the effect of SARS-CoV-2 infection on the potent antifibrinolytic enzyme carboxypeptidase U (CPU). Blood was collected longitudinally from 56 hospitalized COVID-19 patients and 32 healthy controls. Procarboxypeptidase U (proCPU) levels and total active and inactivated CPU (CPU+CPUi) antigen levels were measured. At study inclusion (shortly after hospital admission), proCPU levels were significantly lower and CPU+CPUi antigen levels significantly higher in COVID-19 patients compared to controls. Both proCPU and CPU+CPUi antigen levels showed a subsequent progressive increase in these patients. Hereafter, proCPU levels decreased and patients were, at discharge, comparable to the controls. CPU+CPUi antigen levels at discharge were still higher compared to controls. Baseline CPU+CPUi antigen levels (shortly after hospital admission) correlated with disease severity and the duration of hospitalization. In conclusion, CPU generation with concomitant proCPU consumption during early SARS-CoV-2 infection will (at least partly) contribute to the hypofibrinolytic state observed in COVID-19 patients, thus enlarging their risk for thrombosis. Moreover, given the association between CPU+CPUi antigen levels and both disease severity and duration of hospitalization, this parameter may be a potential biomarker with prognostic value in SARS-CoV-2 infection.
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Affiliation(s)
- Karen Claesen
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - Yani Sim
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - An Bracke
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - Michelle De bruyn
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - Emilie De Hert
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - Gwendolyn Vliegen
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - An Hotterbeekx
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medical & Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (A.H.); (F.H.R.D.W.); (S.K.-S.)
| | - Alexandra Vujkovic
- Clinical Virology Unit, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (A.V.); (K.V.)
| | - Lida van Petersen
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.v.P.); (I.B.); (C.T.); (M.v.F.)
| | - Fien H. R. De Winter
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medical & Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (A.H.); (F.H.R.D.W.); (S.K.-S.)
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.v.P.); (I.B.); (C.T.); (M.v.F.)
| | - Caroline Theunissen
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.v.P.); (I.B.); (C.T.); (M.v.F.)
| | - Sabrina van Ierssel
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, 2650 Edegem, Belgium; (S.v.I.); (E.V.)
| | - Maartje van Frankenhuijsen
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (L.v.P.); (I.B.); (C.T.); (M.v.F.)
| | - Erika Vlieghe
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, 2650 Edegem, Belgium; (S.v.I.); (E.V.)
| | - Koen Vercauteren
- Clinical Virology Unit, Institute of Tropical Medicine, 2000 Antwerp, Belgium; (A.V.); (K.V.)
| | - Samir Kumar-Singh
- Molecular Pathology Group, Laboratory of Cell Biology & Histology, Faculty of Medical & Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (A.H.); (F.H.R.D.W.); (S.K.-S.)
| | - Ingrid De Meester
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
| | - Dirk Hendriks
- Laboratory of Medical Biochemistry, Department of Pharmaceutical Sciences, University of Antwerp, 2610 Wilrijk, Belgium; (K.C.); (Y.S.); (A.B.); (M.D.b.); (E.D.H.); (G.V.); (I.D.M.)
- Correspondence: ; Tel.: +32-3-265-27-27
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