Hemostasis changes and its relationship with SOFA score in sepsis patients

Sarah Hanna Nadya Giri , Adi Koesoema Aman, Achsanuddin Hanafie

Sarah Hanna Nadya Giri
Clinical Pathology Department, H. Adam Malik Hospital, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia. Email: sadonk@hotmail.com

Adi Koesoema Aman
Clinical Pathology Department, H. Adam Malik Hospital, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia

Achsanuddin Hanafie
Anesthesiology and Intensive Therapy Department, H. Adam Malik Hospital, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
Online First: August 01, 2019 | Cite this Article
Nadya Giri, S., Aman, A., Hanafie, A. 2019. Hemostasis changes and its relationship with SOFA score in sepsis patients. Bali Medical Journal 8(2). DOI:10.15562/bmj.v8i2.1409

Introduction: Sepsis is a major health problem, and the incidence is still increasing. Generally, sepsis occurs in about 2% of all inpatients in developed countries. The immunologic response that causes sepsis is a systemic inflammatory response that causes activation of the inflammatory and coagulation pathways. If sepsis untreated, it can lead to organ failure then death. Organ dysfunction is expressed as an acute change of Sequential Organ Failure Assesment (SOFA) score >2 points as a consequence of infection.

Methods: This is a cohort prospective’s study. Prothrombin time (PT), activated partial thromboplastin time (aPTT), Thrombin time (TT), Fibrinogen, D-dimer were examined 3 times (first, second, third day), and then assessed to see its relation with the corresponding SOFA score. Twenty-four subjects of the study were ICU patients in H. Adam Malik Hospital who matched the inclusion and exclusion criteria.

Results: There were significant differences of PT on the first, second and third day (p =0.03). There were no significant differences in aPTT, TT, Fibrinogen, D-dimer on the first, second, third day. There were no significant correlations of PT, aPTT, TT, Fibrinogen with the corresponding SOFA score on the first, second, third day. There was a moderate positive correlation between D-dimer and SOFA score in the first, second and third day of examinations (p <0.05).

Conclusion: PT changes occurred significantly on the first, second, third day of sepsis and D-dimers can be used to asses the risk of organ failure in septic patients.


Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304–77.

Lever A, Mackenzie L. Sepsis: definitions, epidemiology, and diagnosis. BMJ. 2007; 335(7625): 879–883.

Annane D, Bellissant E, Cavaillon J-M. Septic shock. Lancet. 2005;365(9453):63–78.

Karnatovskaia LV, Festic E. Sepsis. Neurohospitalist. 2012; 2(4):144-153

McPherson D, Griffiths C, Williams M, Baker A, Klodawski E, Jacobson B, et al. Sepsis-associated mortality in England: an analysis of multiple cause of death data from 2001 to 2010. BMJ Open. 2013;3(8):e002586.

Danai PA, Moss M, Mannino DM, Martin GS. The Epidemiology of Sepsis in Patients With Malignancy. Chest. 2006;129(6):1432–40.

Phua J, Koh Y, Du B, Tang Y-Q, Divatia J V., Tan CC, et al. Management of severe sepsis in patients admitted to Asian intensive care units: prospective cohort study. BMJ. 2011;342(jun13 1):d3245–d3245.

Pradipta IS, Sodik DC, Lestari K, Parwati I, Halimah E, Diantini A, Abdulah R. Antibiotic Resistance in Sepsis Patients: Evaluation and Recommendation of Antibiotic Use. N Am J Med Sci. 2013; 5(6): 344–352.

Suliarni. Aktifitas Faktor VII pada Sepsis [Internet]. Universitas Sumatra Utara; 2003. Available from: http://library.usu.ac.id/download/fk/patologi-suliarni.pdf [Accessed November 2018]

Fenny, Dalimoenthe NZ, Noormartany, Pranggono E, Dewi NS. Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, dan D-dimer Sebagai Prediktor Decompensated Disseminated Intravascular Coagulation Sisseminated pada Sepsis. Maj Kedokt Bandung. 2011;43(1):49–54.

Puspitasari Y. Analisis Kadar D Dimer untuk Derajat Keparahan Berdasarkan Skor Apache II dan Sofa pada Penderita Sepsis [Internet]. UniversitasAirlangga; 2016. Available from: http://repository.unair.ac.id/id/eprint/55496

Yessica P, Sofro MAU. Faktor Risiko Sepsis pada Pasien Dewasa di RSUP Dr Kariadi. J Kedokt Diponegoro. 2014;3(1). Available from: https://ejournal3.undip.ac.id/index.php/medico/article/view/7989

Melamed A, Sorvillo FJ. The burden of sepsis-associated mortality in the United States from 1999 to 2005: an analysis of multiple-cause-of-death data. Crit Care. 2009;13(1):R28.

Angele MK, Frantz MC, Chaudry IH. Gender and sex hormones influence the response to trauma and sepsis: potential therapeutic approaches. Clinics (Sao Paulo). 2006;61(5):479–88.

Okabayashi K, Wada H, Ohta S, Shiku H, Nobori T, Maruyama K. Hemostatic markers and the sepsis-related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit. Am J Hematol. 2004;76(3):225–9.

Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–10.

Mammen EF. The haematological manifestations of sepsis. J Antimicrob Chemother. 1998;41 Suppl A:17–24.

Yu M, Nardella A, Pechet L. Screening tests of disseminated intravascular coagulation: guidelines for rapid and specific laboratory diagnosis. Crit Care Med. 2000;28(6):1777–80.

Goebel PJ, Williams JB, Gerhardt RT. A Pilot Study of the Performance Characteristics of the D-dimer in Presumed Sepsis. West J Emerg Med. 2010;11(2):173–9.

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