D-dimer corrected for thrombin and plasmin generation is a strong predictor of mortality in patients with sepsis.
Fabrizio Semeraro, Concetta T Ammollo, Pietro Caironi, Serge Masson, Roberto Latini, Mauro Panigada, Antonio Pesenti, Nicola Semeraro, Luciano Gattinoni, Mario Colucci
Abstract
BACKGROUND: D-dimer (DD) is the most used fibrin-related marker and has been proposed, either alone or in combination with other variables, as prognostic factor in patients with sepsis. However, DD generation depends on both coagulation and fibrinolysis, meaning that it may give false negative results in conditions associated with marked fibrinolytic inhibition such as sepsis. In this study, we tested whether correction of DD for thrombin and plasmin generation could improve its prognostic significance in septic patients. MATERIAL AND METHODS: the greater the imbalance in favour of fibrin formation over fibrin lysis, and vice-versa. Primary outcome was 90-day mortality. RESULTS: and SOFA tertiles, we developed a score with high discriminatory power. DISCUSSION: is a good marker of the in vivo coagulation-fibrinolysis balance and displays a prognostic value in sepsis much higher than DD.