Factor XIII in severe sepsis and septic shock

Area of Science:

• Biochemistry
• Hematology
• Critical Care Medicine

Background:

• Sepsis involves coagulation activation and fibrinolysis inhibition, leading to microvascular thrombosis.
• Clot stability is crucial in the pathogenesis of multiple organ dysfunction syndrome.
• Activated Factor XIII (FXIIIa) stabilizes fibrin clots through covalent cross-linking.

Purpose of the Study:

• To investigate the impact of Factor XIII (FXIII) antigen and activity levels on disease severity and fatality in sepsis patients.
• To evaluate FXIII subunit A (FXIIIA), FXIII subunit B (FXIIIB), and FXIII cross-linking activity (FXIIICA) in sepsis.
• To determine the specific activity of FXIII (SA(FXIII)) and its correlation with sepsis outcomes.

Main Methods:

• FXIIIA and FXIIICA were measured in 151 controls and 40 sepsis patients (32 severe sepsis, 8 septic shock).
• FXIIIB was measured in sepsis patients.
• Clotting parameters, FXIII antigen levels, and FXIII activity were determined.

Main Results:

• Sepsis patients had significantly lower FXIIIA and FXIIICA levels compared to healthy controls.
• No significant differences in FXIIIA, FXIIIB, or FXIIICA levels were observed between survivors and non-survivors, or between severe sepsis and septic shock groups.
• The specific activity of FXIII (SA(FXIII)) was significantly higher in sepsis patients and correlated positively with disease severity and fatality.

Conclusions:

• Sepsis is characterized by decreased FXIIICA and FXIIIA levels, alongside elevated SA(FXIII).
• Increased SA(FXIII) is a significant indicator of disease severity and fatality in sepsis patients.
• These findings highlight the complex role of FXIII in sepsis pathophysiology and its potential as a prognostic marker.