Gerinnung bei schwerer Sepsis unter besonderer Berücksichtigung der Monozyten

Sepsis and septic shock almost invariably lead to hemostatic abnormalities. Clinical and experimental studies showed that it is the pathologic disseminated intravascular coagulation (PDIC) that causes microvascular dysfunction, which can result in organ failure. Rapid diagnosis of PDIC is a major challenge in clinical medicine. Many hemostasis parameters are available and the question arises, which of them, especially which of the new ones, can help to start a life rescuing treatment in time. The aim of this thesis was to study markers of cell destruction and hemostasis activation in order to improve the rapid laboratory diagnosis of early severe sepsis. The alterations of hemostasis in septic patients compared to normal plasma were analysed. Plasma of intensive care patients is very unstable. Therefore, in this study EDTA-plasma of intensive care patients or of healthy donors (control group) was stabilized for the first time by supramolar concentrations of arginine before freezing/thawing and analysis. Established markers of PDIC are the thrombocyte count, antithrombin III-activity, fibrinogen- and D-dimer-concentration. The present study showed that quantification in plasma of the in vivo generated circulating amidolytic thrombin activity, fibrinogenfunction/-antigen ratio, tissue factor, sL-selectin, and endotoxin reactivity add much more important information about the pathophysiology of severe sepsis and enable a rapid diagnosis of early sepsis.