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Published on: June 15, 2019
Recent advances in the research and management of sepsis-associated DIC
Toshiaki Iba1, Jean Marie Connors2, Isao Nagaoka3,4
1Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. toshiiba@juntendo.ac.jp.
Insights
Sepsis-associated disseminated intravascular coagulation (DIC) involves systemic coagulation activation and inflammation, leading to organ dysfunction. While diagnosis has improved, effective treatments for this life-threatening condition remain limited, necessitating new therapeutic strategies.
Area of Science:
- Critical care medicine
- Hematology
- Pathophysiology
Background:
- Disseminated intravascular coagulation (DIC) is a severe complication frequently observed in sepsis.
- Sepsis-associated DIC is characterized by excessive coagulation, inhibited fibrinolysis, systemic inflammation, and subsequent organ damage.
- Thrombin plays a crucial role in linking coagulation and inflammation during sepsis-induced DIC.
Purpose of the Study:
- To review the current understanding of the pathophysiology of sepsis-associated DIC.
- To highlight recent advancements in the early and accurate diagnosis of sepsis-associated DIC.
- To underscore the urgent need for novel therapeutic approaches for sepsis-associated DIC.
Main Methods:
- Review of recent scientific literature on sepsis-associated DIC.
- Analysis of the role of key factors such as thrombin, neutrophils, platelets, and damage-associated molecular patterns.
- Evaluation of diagnostic advancements and current treatment limitations.
Main Results:
- Sepsis-associated DIC results from endothelial injury and the activation of multiple factors, including neutrophils, platelets, and DAMPs.
- Thrombin is identified as a central mediator connecting coagulation and inflammation.
- Diagnostic capabilities for sepsis-associated DIC have advanced, enabling earlier and more precise identification.
Conclusions:
- Understanding the complex interplay between coagulation and inflammation in sepsis-associated DIC is critical.
- Despite diagnostic progress, effective treatments for sepsis-associated DIC are still lacking.
- There is a significant unmet need for the development of new therapeutics to improve outcomes for patients with sepsis-associated DIC.
Abstract:
Disseminated intravascular coagulation (DIC) is a common and life-threatening complication in sepsis. Sepsis-associated DIC is recognized as the systemic activation in coagulation with suppressed fibrinolysis that leads to organ dysfunction in combination with systemic intravascular inflammation. In this process, thrombin contributes a key role in connecting both coagulation and inflammation. Endothelial injury, a result of sepsis, causes DIC due to the effect of multiple activated factors that include neutrophils, platelets, and damage-associated molecular patterns. Recent advances in the understanding of pathophysiology have made it possible to diagnose sepsis-associated DIC at earlier timing with better accuracy. However, progress in the treatment is still limited, and new therapeutics for sepsis-associated DIC are needed.
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