Sepsis is associated with systemic inflammatory responses and induction of intravascular
fibrin formation. Our aim is to investigate whether three
fibrin-related markers (FRM) reflect the extent of coagulation activation in vivo and evaluate their clinical usefulness in identifying as well as monitoring patients with
sepsis.
Fibrin-degradation products (
FDP),
D-dimer and soluble
fibrin monomer assays were measured on plasma samples from patients in the ICU with
sepsis (n = 37),
systemic inflammatory response syndrome (SIRS) (n = 35) and healthy individuals (n = 15). The levels were correlated with each other and also with
fibrinogen, prothrombin time, platelets and
antithrombin III. Clinical correlation was also performed for the diagnosis of
sepsis and longitudinal monitoring for survival or death.There was strong correlation between the three FRM (r = 0.38-0.93, P < 0.0001) with only
fibrin monomer correlating significantly with prothrombin time,
fibrinogen and platelet levels. Clinically, all three FRM could discriminate between patients with
sepsis, SIRS and healthy individuals with
FDP, and
D-dimer showing statistical significance (P < 0.05). No FRM predicted outcome from a single measurement but
FDP was significantly able to predict patient survival from serial samples [mean
FDP (μg/ml) from 35.36 to 21.37 (first to third ICU-day), P < 0.05].
Fibrin monomer appears the most sensitive
indicator of coagulation activation, whereas
D-dimer and
FDP levels can significantly differentiate ICU patients with
sepsis from those without. In addition,
FDP would be preferable for monitoring with its statistically significant time-dependent prediction of survival or death from
sepsis.