Consumptive coagulopathy is associated with organ dysfunction during PICS

Area of Science:

• Critical care medicine
• Hematology
• Pulmonology

Background:

• Sepsis survivors can develop persistent inflammation, immunosuppression, and catabolism syndrome (PICS).
• Coagulopathy in chronic critical illness, including PICS, is not fully understood.
• Sepsis involves complex coagulation changes, from hypercoagulability to hypocoagulability.

Purpose of the Study:

• To investigate the association between sepsis-induced PICS and coagulation abnormalities.
• To characterize the hemostatic and lung function changes in a murine PICS model.

Main Methods:

• Establishment of a murine model of PICS via cecal ligation and puncture.
• Assessment of spleen size, splenocyte and megakaryocyte counts after 8 days.
• Pulmonary microvascular thrombi quantification using microscopy.
• Evaluation of lung function parameters (tidal volume, inspiratory time, respiratory rate).
• Thromboelastometry and thrombin level measurements.

Main Results:

• PICS mice exhibited enlarged spleens with increased splenocytes and megakaryocytes, but normal platelet counts.
• Significant increase in pulmonary microvascular thrombi observed in PICS mice.
• Compromised lung function in PICS mice, including decreased tidal volumes and inspiratory times.
• Thromboelastometry revealed delayed clot initiation but increased clot firmness.
• Delayed thrombin production and reduced overall thrombin concentrations were noted.

Conclusions:

• Sepsis-induced PICS is associated with significant coagulation dysregulation.
• Microthrombus formation and impaired lung function are key features of PICS.
• Consumptive coagulopathy may be a cardinal feature of PICS, contributing to organ damage.