• Kansuke Koyama, Seiji Madoiwa, Shinichiro Tanaka, Toshitaka Koinuma, Masahiko Wada, Asuka Sakata, Tsukasa Ohmori, Jun Mimuro, Shin Nunomiya, and Yoichi Sakata.
• Division of Intensive Care, Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan; Research Division of Cell and Molecular Medicine, Center of Molecular Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. Electronic address: k_koyama@jichi.ac.jp.
• J Crit Care. 2013 Oct 1;28(5):556-63.

PurposeThe hemostatic biomarkers for early diagnosis of sepsis-associated coagulopathy have not been identified. The purpose of this study was to evaluate hemostatic biomarker abnormalities preceding a decrease in platelet count, which is a surrogate indicator of overt coagulopathy in sepsis.Materials And MethodsSeventy-five septic patients with a platelet count more than 80×10(3)/μL were retrospectively analyzed. Hemostatic biomarkers at intensive care unit admission were compared between patients with and patients without a subsequent decrease in platelet count (≥30% within 5 days), and the ability of biomarkers to predict a decrease in platelet count was evaluated.ResultsForty-two patients (56.0%) developed a subsequent decrease in platelet count. Severity of illness, incidence of organ dysfunction, and 28-day mortality rate were higher in patients with a subsequent decrease in platelet count. There were significant differences between patients with and patients without a subsequent decrease in platelet count in prothrombin time-international normalized ratio, fibrinogen, thrombin-antithrombin complex, antithrombin, protein C (PC), plasminogen, and α2-plasmin inhibitor (α2-PI). Receiver operating characteristic curve analysis showed that PC (area under the curve, 0.869; 95% confidence interval, 0.699-0.951) and α2-PI (area under the curve, 0.885; 95% confidence interval, 0.714-0.959) were strong predictors of a subsequent decrease in platelet count.ConclusionsDecreased PC and α2-PI activity preceded a decrease in platelet count in intensive care unit patients with sepsis.Copyright © 2013 Elsevier Inc. All rights reserved.

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