In Figure Figure2,2, the results obtained by both the thromboelastometry lysis index and conventional biomarkers selleck EPZ-5676 (a) as well as the thromboelastometry clotting variables (b) are summarized. The figure demonstrates that the lysis index is not different in probands and postoperative patients but is significantly higher in patients with severe sepsis. Similarly, procalcitonin slightly increases in postoperative patients and shows a further marked increase in patients with severe sepsis. In contrast, interleukin 6 and C-reactive protein are markedly higher in postoperative patients, but no further increase is found in patients with severe sepsis. Thus, thromboelastometry lysis index and procalcitonin, but not interleukin 6 and C-reactive protein, are capable of detecting patients with severe sepsis in critically ill adults.

Concerning the thromboelastometry clotting variables clotting time, alpha angle, and clot-formation time, the present study demonstrates an increased hemostasis potential in postoperative patients (Figure (Figure2b);2b); maximum clot firmness was not different in these groups. The differences observed between postoperative patients and patients with severe sepsis were small, not significant in most cases, and thus do not allow detection of the patients with severe sepsis.Figure 2Thromboelastometry variables and conventional biomarkers in probands (1), postoperative patients (2), and patients with sepsis (3), respectively. Data are given as mean and standard error of the mean. The asterisks denote significant differences between …

It is a main result of the present study that the thromboelastometry lysis index was increased in patients with severe sepsis in comparison with probands and postoperative patients, suggesting that the function of the fibrinolytic system is markedly inhibited. Whereas clot firmness decreased by 8% after 1 hour in patients without sepsis and in probands, clot firmness decreased by only 3% in patients with severe sepsis. The fact that the thromboelastometry lysis index was the most reliable biomarker tested for the diagnosis of severe sepsis in critically ill patients in our study demonstrates that thromboelastometry is capable of detecting changes in the fibrinolytic system in severe sepsis. Furthermore, because changes in thromboelastometry variables were seen on the day of diagnosis of severe sepsis, our data demonstrate an early involvement of the fibrinolysis system occurring in almost all patients (84.2%) with severe sepsis. In this regard, it is important that Brefeldin_A the thromboelastometry lysis index is not different in probands and postoperative patients.