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Postoperative hemostatic profile in relation to gram-negative septicemia
Critical Care Medicine
|May 1, 1982
Summary
Persistent low levels of antithrombin III (AT III) and plasminogen (PLG) after surgery may indicate developing gram-negative septicemia in ICU patients. This finding offers an early warning sign for this serious infection.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- Gram-negative septicemia is a significant challenge in intensive care units (ICUs).
- Diagnosis of septicemia typically relies on clinical signs and blood cultures, which have a delayed result.
- Surgical procedures can impact the hemostatic profile, specifically antithrombin III (AT III) and plasminogen (PLG) levels.
Purpose of the Study:
- To investigate the relationship between changes in the hemostatic profile and the development of postoperative gram-negative septicemia in surgical ICU patients.
- To identify early indicators of septicemia beyond traditional clinical signs and blood cultures.
Main Methods:
- Seventy-six surgical ICU patients were monitored preoperatively and for 10 days postoperatively.
- Hemostatic markers, including AT III, plasminogen (PLG), and alpha 2antiplasmin (alpha 2AP), were measured.
- Patients were categorized into groups with and without gram-negative septicemia, confirmed by positive blood cultures.
Main Results:
- Patients who developed gram-negative septicemia showed significantly lower postoperative AT III and PLG levels compared to those without septicemia.
- These reduced AT III and PLG levels persisted after the third postoperative day in septicemic patients.
- Alpha 2antiplasmin (alpha 2AP) levels behaved similarly in both groups.
- The observed differences in hemostatic profiles preceded clinical manifestations and positive blood cultures by several days.
- Leukocyte and platelet counts did not reliably predict early septicemia development.
Conclusions:
- Persistent low plasma AT III and PLG levels in the postoperative phase serve as early indicators of developing gram-negative septicemia.
- Monitoring AT III and PLG levels could aid in the early detection of septicemia in surgical ICU patients.
- This hemostatic profile change offers a predictive marker for gram-negative septicemia, preceding traditional diagnostic methods.