Description:
Introduction: Sepsis is a complex pathophysiological disorder arising from systemic inflammatory
response to infection. The inflammatory cascade has two limbs: one- inflammatory and one- pro-coagulant. Endothelium plays an important role in activation of clotting system and, simultaneous, in suppression of fibrinolitic system, that appears to be an essential component in the development of multi-organ
failure (MOF). The objective of this study is analysing and describing clinical signs and biochemical values in adults with sepsis syndrome, which could allow the screening of indirect features of sepsis followed
by early treatment as soon as possible.
Methods: Thirty patients meeting the inclusion criteria who got admitted to the ICU at Municipal
Clinical Hospital N3, Chisinau, between 2008-2010 were studied. Detailed history was taken and physical examination performed. Patients were investigated according to the clinical situation as defined by
criteria set by the ACCP/SCCM Consensus Committee. Biochemical values were done on admission to
detect metabolic derangements and organ dysfunction. The tests were repeated during 7 days depending
on the severity of the derangement.
Results: Tie patients were divided into two groups: the first group-20 patients with septic complications and the second group- 10 non-septic patients. The comparative analyze of biochemical profiles was
performed between the groups. Ihus, in the first group, on admission, the average level of fibrinogen is
5,102 g/1 and the average level of indirect bilirubin is 20,14 mcmol/1. The correlation coefficient between
prothrombin and ASAT is - 0,89434. In the second group, on admission, the average level of fibrinogen
is 5,14 g/1 and the average level of indirect bilirubin is 29,16 mcmol/1. The correlation coefficient between
prothrombin and ASAT is 0,091.
Conclusions: Biochemical profile analyze of patients from both groups reveals a multiple organ
dysfunction (MOD) in first hours of septic process. Thus, the indirect relation between hepotocyte injury markers iALAT/ASAT and prothrombin reveals hepatic failure, triggered in first hours of sepsis.
Fibrinogen elevated levels in first 24-72 h reveals the suppression of fibrinolysis and the activation of
clotting system with the spread of nncrothrombi in the microcirculatory bed and perfusion disorders.
Hyperbilirubinemia due to indirect bilirubin confirms hepatocyte affection with the involvement of microsomal enzyme systems, which are exhausted in hypercatabolism conditions and ATP deficiency.The
study confirms the alteration of clotting system, even in the first hours of septic process installation and
the necessity of early supervised thrombolytic therapy.
In the absence of specific markers in sepsis diagnosis, we could sense the evolution of septic complications through indirect analyze of patient s biochemical profile with the early begining of resuscitation
therapy.