Die Bedeutung der Gerinnung für die Prognose von Patienten mit Sepsis

  • H. Böhrer
Conference paper


Da die Definition der Sepsis sehr weitgefasst ist [1], ergibt sich für die Einschätzung der Prognose von septischen Patienten eine ganze Reihe von Ansätzen (s. folgende Übersicht). Der „klinische Blick“ des erfahrenen Intensivmediziners oder auch das „gut feeling“ des Operateurs [13] werden im heutigen Zeitalter der evidenzbasierten Medizin immer mehr in den Hintergrund treten. Man versucht heute, diesen klinischen Blick mit Hilfe von Scoresystemen zu quantifizieren. Für den septischen Patienten stehen allgemeine Scores wie der APACHE II oder III zur Verfügung. Einzelne Untersucher bevorzugen allerdings den Einsatz spezieller Scoresysteme wie z. B. den Sepsisscore von Elebute u. Stoner [8].


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  1. 1.
    American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874CrossRefGoogle Scholar
  2. 2.
    Assicot M, Gendrei D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341: 515–518PubMedCrossRefGoogle Scholar
  3. 3.
    Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL (1996) Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 171: 221–226PubMedCrossRefGoogle Scholar
  4. 4.
    Bernard GR, Vincent JL, Laterre PF. (Recombinant Human Protein C Worldwide Evaluation in Severe Sepsis [PROWESS] Study Group) (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344: 699–709Google Scholar
  5. 5.
    Biemond BJ, Levi M, ten Cate H et al. (1995) Complete inhibition of endotoxin-induced coagulation activation in chimpanzees with a monoclonal Fab fragment against factor VII/VIIa. Thromb Haemost 73: 223–230PubMedGoogle Scholar
  6. 6.
    Bohrer H, Qiu F, Zimmermann T et al. (1997) Role of NFKB in the mortality of sepsis. J Clin Invest 100: 972–985PubMedCrossRefGoogle Scholar
  7. 7.
    Döcke WD, Randow F, Syrbe U et al. (1997) Monocyte deactivation in septic patients: restoration by IFN-γ treatment. Nature Medicine 3: 678–681PubMedCrossRefGoogle Scholar
  8. 8.
    Elebute EA, Stoner HB (1983) The grading of sepsis. Br J Surg 70: 29–31PubMedCrossRefGoogle Scholar
  9. 9.
    Fijnvandraat K, Derkx B, Peters M et al. (1995) Coagulation activation and tissue necrosis in meningococcal septic shock: severely reduced protein C levels predict a high mortality. Thromb Haemost 73: 15–20PubMedGoogle Scholar
  10. 10.
    Fisher CJ, Yan SB (2000) Protein C levels as a prognostic indicator of outcome in sepsis and related diseases. Crit Care Med 28 (Suppl): S49–S56PubMedCrossRefGoogle Scholar
  11. 11.
    Fourrier F, Chopin C, Goudemand J. (1992) Septic shock, multiple organ failure, and disseminated intravascular coagulation. Compared patterns of antithrombin III, protein C, and protein S deficiencies. Chest 101: 816–623Google Scholar
  12. 12.
    Gawaz M, Dickfeld T, Bogner C, Fateh-Moghadam S, Neumann FJ (1997) Platelet function in septic multiple organ dysfunction syndrome. Intensive Care Med 23: 379–385PubMedCrossRefGoogle Scholar
  13. 13.
    Hartley MN, Sagar PM (1994) The surgeon’s gut as a predictor of post-operative outcome. Ann R Coll Surg Engl 76 (6 Suppl): 277–278PubMedGoogle Scholar
  14. 14.
    Hermans PW, Hibberd ML, Booy R, Daramola O, Hazelzet JA, de Groot R, Levin M (1999) 4G/5G promoter polymorphism in the plasminogen-activator-inhibitor-1 gene and outcome of meningococcal disease. Meningococcal Research Group. Lancet 354: 556–560Google Scholar
  15. 15.
    Hesselvik JF, Malm J, Dahlback B, Blomback M (1991) Protein C, protein S and C4b-binding protein in severe infection and septic shock. Thromb Haemost 65: 126–129PubMedGoogle Scholar
  16. 16.
    Kimura S, Yoshioka T, Shibuya M, Sakano T, Tanaka R, Matsuyama S (2001) Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival. Crit Care Med 29: 1159–1163PubMedCrossRefGoogle Scholar
  17. 17.
    Levi M, ten Cate H, Bauer KA et al. (1994) Inhibition of endotoxin-induced activation of coagulation and fibrinolysis by pentoxifylline or by a monoclonal anti-tissue factor antibody in chimpanzees. J Clin Invest 93: 114–120PubMedCrossRefGoogle Scholar
  18. 18.
    Lorente JA, Garcia-Frade LJ, Landin L, de Pablo R, Torrado C, Renes E, Garcia-Avello A (1993) Time course of hemostatic abnormalities in sepsis and its relation to outcome. Chest 103: 1536–1542Google Scholar
  19. 19.
    Mason JW, Kleeberg U, Dolan P, Colman RW (1970) Plasma kallikrein and Hageman factor in Gram-negative bacteremia. Ann Intern Med 73: 545–551PubMedGoogle Scholar
  20. 20.
    Menges T, Hermans PW, Little SG et al. (2001) Plasminogen-activator-inhibitor-1 4G/5G promoter polymorphism and prognosis of severely injured patients. Lancet 357: 1096–1097PubMedCrossRefGoogle Scholar
  21. 21.
    Mesters RM, Florke N, Ostermann H, Kienast J (1996) Increase of plasminogen activator inhibitor levels predicts outcome of leukocytopenic patients with sepsis. Thromb Haemost 75: 902–907PubMedGoogle Scholar
  22. 22.
    Mesters RM, Mannucci PM, Coppola R, Keller T, Ostermann H, Kienast J (1996) Factor Vila and antithrombin III activity during severe sepsis and septic shock in neutropenic patients. Blood 88: 881–886PubMedGoogle Scholar
  23. 23.
    Muller B, Peri G, Doni A, Torri V, Landmann R, Bottazzi B, Mantovani A (2001) Circulating levels of the long pentraxin PTX3 correlate with severity of infection in critically ill patients. Crit Care Med 29: 1404–1407PubMedCrossRefGoogle Scholar
  24. 24.
    Patel RT, Deen KI, Youngs D, Warwick J, Keighley MR (1994) Interleukin 6 as a prognostic indicator of outcome in severe intra-abdominal sepsis. Br J Surg 81: 1306–1308PubMedCrossRefGoogle Scholar
  25. 25.
    Pixley RA, de La Cadena R, Page JD. (1993) The contact system contributes to hypotension but not disseminated intravascular coagulation in lethal bacteremia. In vivo use of a monoclonal anti-factor XII antibody to block contact activation in baboons. J Clin Invest 91: 61–68Google Scholar
  26. 26.
    Pralong G, Calandra T, Glauser MP, Schellekens J, Verhoef J, Bachmann F, Kruithof EK (1989) Plasminogen activator inhibitor 1: a new prognostic marker in septic shock. Thromb Haemost 61: 459–462PubMedGoogle Scholar
  27. 27.
    Sabharwal AK, Bajaj SP, Ameri A et al. (1995) Tissue factor pathway inhibitor and von Willebrand factor antigen levels in adult respiratory distress syndrome and in a primate model of sepsis. Am J Respir Crit Care Med 151: 758–767PubMedGoogle Scholar
  28. 28.
    Sigurdsson GH, Christenson JT, el-Rakshy MB, Sadek S (1992) Intestinal platelet trapping after traumatic and septic shock. An early sign of sepsis and multiorgan failure in critically ill patients? Crit Care Med 20: 458–467PubMedCrossRefGoogle Scholar
  29. 29.
    Stiiber F, Petersen M, Bokelmann F, Schade U (1996) A genomic polymorphism within the tumor necrosis factor locus influences plasma tumor necrosis factor-alpha concentrations and outcome of patients with sepsis. Crit Care Med 24: 381–384CrossRefGoogle Scholar
  30. 30.
    Suffredini AF, Harpel PC, Parrillo JE (1989) Promotion and subsequent inhibition of plasminogen activation after administration of intravenous endotoxin to normal subjects. N Engl J Med 320: 1165–1172PubMedCrossRefGoogle Scholar
  31. 31.
    Tracey KJ, Beutler B, Lowry SF et al. (1986) Shock and tissue injury induced by recombinant human cachectin. Science 234: 470–474PubMedCrossRefGoogle Scholar
  32. 32.
    Tracey KJ, Fong Y, Hesse DG et al. (1987) Anti-cachectin/TNF monoclonal antibodies prevent septic shock during lethal bacteraemia. Nature 330: 662–664PubMedCrossRefGoogle Scholar
  33. 33.
    van Deventer SJ, Buller HR, ten Cate JW, Aarden LA, Hack CE, Sturk A (1990) Experimental endotoxemia in humans: analysis of cytokine release and coagulation, fibrinolytic, and complement pathways. Blood 76: 2520–2526PubMedGoogle Scholar
  34. 34.
    Weigand MA, Schmidt H, Pourmahmoud M, Zhao Q, Martin E, Bardenheuer HJ (1999) Circulating intercellular adhesion molecule-1 as an early predictor of hepatic failure in patients with septic shock. Crit Care Med 27: 2656–2661PubMedCrossRefGoogle Scholar
  35. 35.
    Yentis SM, Soni N, Sheldon J (1995) C-reactive protein as an indicator of resolution of sepsis in the intensive care unit. Intensive Care Med 21: 602–605PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2002

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  • H. Böhrer

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