Sepsis and septic shock: endothelial molecular pathogenesis associated with vascular microthrombotic disease

Thrombosis Journal

Table 3 Differential features of sepsis-associated “DIC” and other thrombo-coagulopathies

	“DIC” without hepatic coagulopathy	“DIC” with hepatic coagulopathy	EA-VMTD/DIT without hepatic coagulopathy	True DIC
Associated disease	Sepsis Other critical illnesses	Sepsis Other critical illnesses FHF	Sepsis Other critical illnesses	APL
Mechanism
Complement activation	+	+	+	No evidence
Endotheliopathy	+	+	+	No evidence
Inflammatory path	Activated	Activated	Activated	No evidence
Activated hemostatic path	ULVWF	ULVWF	ULVWF	Aberrant TF path
Thrombogenesis	Via micothrombogenesis	Via micothrombogenesis	Via micothrombogenesis	Via fibrinogenesis
Liver involvement	None	FHF	None	Unlikely to occur
Pathology
Coagulation disorder	VMTD	VMTD with FHF	VMTD	Hemorrhagic disorder
Character of blood clots	Microthrombi	Microthrombi	Microthrmbi	Fibrin clots
Nature of blood clot	Platelet + ULVWF	Platelet +ULVWF	Platelet +ULVWF	Fibrin meshes
Hematology
Platelet	Decreased	Decreased	Decreased	Decreased due to APL
MAHA	+	+	+	–
FVIII	Normal/increased	Markedly increased	Normal/increased	Markedly decreased
PT/aPTT	Normal	Prolonged	Normal	Prolonged
Fibrinogen	Normal	Decreased	Normal	Decreased
Clinical Phenotype	MODS	MODS	MODS	Hemorrhagic syndrome
	TTP-like syndrome	TTP-like syndrome	TTP-like syndrome
	Chronic “DIC”	Acute “DIC”	EA-VMTD/DIT
	Chronic “DIC”	FHF	EA-VMTD/DIT
Correct diagnosis	EA-VMTD/DIT	EA-VMTD/DIT with hepatic coagulopathy	EA-VMTD/DIT	True DIC
Disease designation	EA-VMTD	EA-VMTD with hepatic coagulopathy	EA-VMTD	Consumption coagulopathy

Abbreviations: APL acute promyelocytic leukemia, DIC disseminated intravascular coagulation, “DIC” ill-founded DIC, DIT disseminated intravascular microthrombosis, FHF fulminant hepatic failure, MAHA microangiopathic hemolytic anemia, MODS multiorgan dysfunction syndrome, PT prothrombin time, aPTT activated partial thromboplastin time, TTP thrombotic thrombocytopenic purpura, ULVWF unusually large von Willebrand factor multimers, EA-VMTD endotheliopathy-associated vascular microthrombotic disease
^aPlease note that “DIC” without hepatic coagulopathy is exactly the same to EA-VMTD/DIT without hepatic coagulopathy, which is also consistent with the thesis that “DIC” is DIT

ISSN: 1477-9560