Early Detection of Disseminated Intravascular Coagulation During Septic Shock: A Multicentre Prospective Study.

Objectives: Inadequate stratification of septic shock patients may result in inappropriate treatment allocation in randomized clinical trials, especially regarding anticoagulant. We previously reported that endothelial-derived microparticles are relevant biomarkers of sepsis-induced disseminated intravascular coagulation. In this validation cohort, we assess microparticles as surrogates of cell activation to improve early disseminated intravascular coagulation diagnosis and patient stratification. Design: Prospective observational study in septic shock patients. Settings: Four medical ICUs in university hospitals. Patients and Methods: Two hundred sixty-five patients with septic shock from four ICUs were consecutively enrolled. Disseminated intravascular coagulation was diagnosed according to Japanese Association for Acute Medicine 2006 score. Endothelial- and leukocyte-derived circulating procoagulant microparticles were isolated and quantified by prothrombinase assay at admission, day 3, and day 7. Intervention: None. Measurements and Main Results: Two hundred fifty-nine patients were analyzed. Sixty-one had disseminated intravascular coagulation at admission, and 32 developed disseminated intravascular coagulation during the first 24 hours after admission. Multiple logistic regression model confirmed that endothelial cell-derived microparticles were associated with disseminated intravascular coagulation: CD105+-microparticles (odds ratio, 2.13) and CD31+-microparticles (odds ratio, 0.65) (p 0.60 nM eq. PhtdSer; odds ratio, 1.67; p

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