Septic shock is characterized by a dysregulated response to infection, hypotension and activation of the coagulation system. Markers of coagulation activation are commonly used to diagnose and monitor ensuing coagulopathies. In this study, we sought to determine levels of circulating thrombin in patients with septic shock. To characterize levels of circulating, active thrombin in patients with septic shock. 48 patients with septic shock were included in this prospective, observational study. Blood samples were obtained on admission, day 1, day 3 and day 6. Levels of active thrombin were measured using a standardized, clinically applicable oligonucleotide (aptamer)-based enzyme-capture assay (OECA). Thrombin levels were correlated with established indirect thrombin parameters, conventional coagulation tests, laboratory parameters, patient characteristics and outcome. Elevated levels of thrombin were detected in 27 patients (56.3%) during the course of the study. Thrombin levels were positively correlated with thrombin-antithrombin complexes (r = 0.30, p < 0.05) and negatively associated with FVII levels (r = − 0.28, p < 0.05). Thrombin levels on admission did not predict 30-day mortality (OR 0.82, 95% CI 0.23–2.92, p = 0.77). Circulating levels of active thrombin can be measured in a subset of patients with septic shock. Although thrombin levels are correlated with established markers of coagulation, they do not provide additional prognostic information.
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The datasets analysed are available from the corresponding author on reasonable request.
Analysis of variance
- APACHE II:
Acute physiology and chronic health evaluation II
Activated protein C
Activated partial thromboplastin time
Disseminated intravascular coagulation
- F1 + F2:
Prothrombin activation fragment F1 + 2
Coagulation factor VII
Intensive care unit
International normalized ratio
Lower limit of quantification
New oral anticoagulant
Oligonucleotide (aptamer)-based enzyme-capture assay
Simplified Acute Physiology Score
Vitamin K antagonist
White blood cell count
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The authors thank the Klaus Tschira Charitable Foundation for its kind support. The authors further thank Simone Gasper for expert technical assistance.
This study was funded by the Klaus Tschira Charitable Foundation (Grant No. 00.271.2015).
Conflict of interest
Martin Borggrefe declares financial relations, including speaker honoraria and research grants, with Boston Scientific, Medtronic, Impulse Dynamics, St. Jude Medical, CVRx, Biotronic, Pfizer, Bayer and Böhringer-Ingelheim. All other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (University of Heidelberg, Germany; reference number 2015-526N-MA) and with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
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Becher, T., Müller, J., Akin, I. et al. Characterization of circulating thrombin in patients with septic shock: a prospective observational study. J Thromb Thrombolysis 50, 90–97 (2020). https://doi.org/10.1007/s11239-019-01992-w
- Shock, septic