Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study
Abstract Background Recent studies have suggested that anticoagulant therapy does not confer a survival benefit overall in sepsis, but might be beneficial in sepsis-associated disseminated intravascular coagulation (DIC). In particular, those with high Sequential Organ Failure Assessment (SOFA) scor...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-12-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-019-0420-2 |
| _version_ | 1818448488998895616 |
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| author | Takashi Ito Takaaki Totoki Yayoi Yokoyama Tomotsugu Yasuda Hiroaki Furubeppu Shingo Yamada Ikuro Maruyama Yasuyuki Kakihana |
| author_facet | Takashi Ito Takaaki Totoki Yayoi Yokoyama Tomotsugu Yasuda Hiroaki Furubeppu Shingo Yamada Ikuro Maruyama Yasuyuki Kakihana |
| author_sort | Takashi Ito |
| collection | DOAJ |
| description | Abstract Background Recent studies have suggested that anticoagulant therapy does not confer a survival benefit overall in sepsis, but might be beneficial in sepsis-associated disseminated intravascular coagulation (DIC). In particular, those with high Sequential Organ Failure Assessment (SOFA) scores might be the optimal target for anticoagulant therapy. However, both DIC and SOFA scores require the measurement of multiple markers. The purpose of this study was to explore a minimal marker set for determining coagulopathy at high risk of death in septic patients, wherein histone H3 levels were evaluated as indicators of both organ failure and coagulation activation. Methods We analyzed correlations among levels of serum histone H3 and other coagulation markers in 85 cases of sepsis using Spearman’s rank correlation test. We then compared the utility of histone H3 to that of other coagulation markers in predicting the traditional DIC state or 28-day mortality by receiver-operating characteristics analysis. Finally, we suggested cut-off values for determining coagulopathy with high risk of death, and evaluated their prognostic utility. Results Serum histone H3 levels significantly correlated with thrombin-antithrombin complex (TAT) levels (Spearman’s ρ = 0.46, p < 0.001), and weakly correlated with platelet counts (Spearman’s ρ = − 0.26, p < 0.05). Compared to other coagulation markers, histone H3 levels showed better performance in predicting 28-day mortality. When combining serum histone H3 levels with platelet counts, our new scoring system showed a concordance rate of 69% with the traditional four-factor criteria of DIC established by the Japanese Association for Acute Medicine. The 28-day mortality rates of the new and the traditional criteria-positive patients were 43% and 21%, respectively. Those of the new and the traditional criteria-negative patients were 5.7% and 9.4%, respectively. Conclusions Serum histone H3 levels and platelet counts are potential markers for determining coagulopathy with high risk of death in septic patients. Further studies are needed to clarify the utility of serum histone H3 levels in the diagnostic of coagulopathy/DIC. |
| first_indexed | 2024-12-14T20:20:19Z |
| format | Article |
| id | doaj.art-555b3bbba69d4ed781362a6bd196d2cf |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-12-14T20:20:19Z |
| publishDate | 2019-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-555b3bbba69d4ed781362a6bd196d2cf2022-12-21T22:48:44ZengBMCJournal of Intensive Care2052-04922019-12-01711710.1186/s40560-019-0420-2Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational studyTakashi Ito0Takaaki Totoki1Yayoi Yokoyama2Tomotsugu Yasuda3Hiroaki Furubeppu4Shingo Yamada5Ikuro Maruyama6Yasuyuki Kakihana7Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental SciencesR&D Center, Shino-Test CorporationDepartment of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental SciencesDepartment of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental SciencesAbstract Background Recent studies have suggested that anticoagulant therapy does not confer a survival benefit overall in sepsis, but might be beneficial in sepsis-associated disseminated intravascular coagulation (DIC). In particular, those with high Sequential Organ Failure Assessment (SOFA) scores might be the optimal target for anticoagulant therapy. However, both DIC and SOFA scores require the measurement of multiple markers. The purpose of this study was to explore a minimal marker set for determining coagulopathy at high risk of death in septic patients, wherein histone H3 levels were evaluated as indicators of both organ failure and coagulation activation. Methods We analyzed correlations among levels of serum histone H3 and other coagulation markers in 85 cases of sepsis using Spearman’s rank correlation test. We then compared the utility of histone H3 to that of other coagulation markers in predicting the traditional DIC state or 28-day mortality by receiver-operating characteristics analysis. Finally, we suggested cut-off values for determining coagulopathy with high risk of death, and evaluated their prognostic utility. Results Serum histone H3 levels significantly correlated with thrombin-antithrombin complex (TAT) levels (Spearman’s ρ = 0.46, p < 0.001), and weakly correlated with platelet counts (Spearman’s ρ = − 0.26, p < 0.05). Compared to other coagulation markers, histone H3 levels showed better performance in predicting 28-day mortality. When combining serum histone H3 levels with platelet counts, our new scoring system showed a concordance rate of 69% with the traditional four-factor criteria of DIC established by the Japanese Association for Acute Medicine. The 28-day mortality rates of the new and the traditional criteria-positive patients were 43% and 21%, respectively. Those of the new and the traditional criteria-negative patients were 5.7% and 9.4%, respectively. Conclusions Serum histone H3 levels and platelet counts are potential markers for determining coagulopathy with high risk of death in septic patients. Further studies are needed to clarify the utility of serum histone H3 levels in the diagnostic of coagulopathy/DIC.https://doi.org/10.1186/s40560-019-0420-2SepsisDisseminated Intravascular coagulation (DIC)DiagnosisHistone |
| spellingShingle | Takashi Ito Takaaki Totoki Yayoi Yokoyama Tomotsugu Yasuda Hiroaki Furubeppu Shingo Yamada Ikuro Maruyama Yasuyuki Kakihana Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study Journal of Intensive Care Sepsis Disseminated Intravascular coagulation (DIC) Diagnosis Histone |
| title | Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study |
| title_full | Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study |
| title_fullStr | Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study |
| title_full_unstemmed | Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study |
| title_short | Serum histone H3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients: a single-center observational study |
| title_sort | serum histone h3 levels and platelet counts are potential markers for coagulopathy with high risk of death in septic patients a single center observational study |
| topic | Sepsis Disseminated Intravascular coagulation (DIC) Diagnosis Histone |
| url | https://doi.org/10.1186/s40560-019-0420-2 |
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