Coagulation disorders in patients with cirrhosis and severe sepsis
Article first published online: 27 NOV 2003
Volume 23, Issue 6, pages 440–448, December 2003
How to Cite
Plessier, A., Denninger, M.-H., Consigny, Y., Pessione, F., Francoz, C., Durand, F., Francque, S., Bezeaud, A., Chauvelot-Moachon, L., Lebrec, D., Valla, D.-C. and Moreau, R. (2003), Coagulation disorders in patients with cirrhosis and severe sepsis. Liver International, 23: 440–448. doi: 10.1111/j.1478-3231.2003.00870.x
- Issue published online: 27 NOV 2003
- Article first published online: 27 NOV 2003
- Received 21 July 2003, accepted 11 September 2003
- organ failure;
Background: In patients with cirrhosis, severe sepsis may stimulate the extrinsic coagulation pathway resulting in thrombin generation and fibrin formation.
Aims: 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.