Sepsis-induced coagulopathy: recent insights on the role and clinical application of neutrophil extracellular trap formation

Sepsis is characterized by life-threatening organ dysfunction caused by an uncontrolled immune response to infection. Neutrophils play a vital role in this process, which can lead to immunothrombosis and disseminated intravascular coagulation (DIC) via the formation of neutrophil extracellular traps (NETs). This study aimed to validate the impact of NETs biomarkers in evaluating their potential as diagnostic, prognostic, and therapeutic indicators in critical care for patients with sepsis. We conducted a case-control study with a 7-day follow-up to assess mortality in 138 sepsis patients, focusing specifically on the occurrence of DIC. Additionally, 80 healthy volunteers, matched by age and sex, served as controls. Our findings reveal a strong connection between histones in sepsis and both the initial inflammatory response and sepsis-related coagulopathy/DIC. Furthermore, we found that myeloperoxidase can effectively predict short-term mortality among sepsis patients, regardless of their DIC status. This study highlights a concerning simultaneous increase in myeloperoxidase and histones (thresholds of > 84.9 ng/ml and > 126.4 ng/ml, respectively), which may serve as vital indicators indicating the urgent need for NETs inhibitors in sepsis treatment. Applying this approach, we anticipate a significant reduction in thrombotic events and mortality, thereby enhancing patient care and outcomes in the management of critical sepsis.