Elevated plasma D-dimer level and the presence of septic shock in patients with sepsis

Background: Sepsis induces dysfunction in organ systems, including the hemostatic system. D-dimer is generated during disseminated intravascular coagulation (DIC), and so elevated D-dimer levels may be associated with progression of sepsis to septic shock. Objective: We evaluated whether abnormal D-dimer levels were associated with presence of septic shock. Design: Retrospective cross- sectional study. Methods: We studied 137 patients diagnosed with sepsis who underwent testing for D-dimer. D-dimer level below 0.4 mg/L fibrinogen equivalent unit (FEU) was considered unchange. D-dimer level above 0.4 and below 4 mg/L FEU was considered moderate elevation, D-dimer level above 4 mg/L FEU was considered strong elevation. Results: Septic shock was diagnosed in 52 (38%) patients. DIC occurred in 38 (27.7%) patients. Patients with unchanged, moderately elevated and strongly elevated D dimer levels were 1(7%), 43 (31.4%) and 93 (67.9%); respectively. Compared to the patients with sepsis without shock, those with septic shock had a longer activated partial thromboplastin time (APTT) (37.5 vs 34.5 s), higher D-dimer level (7.65 vs 5.15 mg/L FEU), higher procalcitonin level (13.5 vs 5.57 ng/mL), but a lower platelet count (93 vs 130 × 10 9 /L), ( p < .05). The frequency of septic shock in patients with DIC was higher than that in patients group without DIC (50% vs 33.3%), but the difference was not statistically significant ( p = .072). Univariate regression analysis showed that prolonged APTT, high D-dimer level, high procalcitonin level, and low platelet count were associated with the presence of septic shock. However, multivariate regression analysis determined that only a low platelet count was significantly associated with septic shock. Conclusion: Among the patients with sepsis, thrombocytopenia but not elevated plasma D-dimer level is associated with risk of septic shock.