[Disturbances in coagulation, fibrinolytic and complement systems in septic shock]

Plasma levels of selected proteins of coagulation, fibrinolysis and complement from patients with septic shock have been investigated. All values were corrected on the basis of a plasma protein content of 5.5%. Considerable decreases were found in the plasma levels of the contact factors activity. The antigen content in the case of HMW-kininogen remained in the normal range, whereas in the case of prekallikrein it dropped to about 30% of norm. Considering the proteins of the unspecific defense and the complement system, primarily HRG, alpha 2-macroglobulin and C4 showed remarkable decreases. From the changes of the plasma levels of the considered proteins one can conclude that in septic shock primarily the contact phase of coagulation and the alternative pathway of complement are involved. The consumption of F XIII points to a thrombin generation during shock. The marked reduction of the C4-component could be due to an isolated proteolysis of this component, since the classical pathway of complement activation seems not to be involved in the shock events. Serial controls of the plasma levels of the proteins under investigation showed in some patients considerable individual deviations from the general trend. A considerable increase of the F XIII A level appears to be a prognostically favorable result, whereas constantly low values of F XIII and fibronectin without a tendency to normalization or a constant decrease of these proteins often is connected with a fatal outcome.