Publication: Induced normothermia ameliorates the procoagulant host response in human endotoxaemia
Issued Date
2021-06-01
Resource Type
ISSN
14716771
00070912
00070912
Other identifier(s)
2-s2.0-85105628450
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Mahidol University
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SCOPUS
Bibliographic Citation
British Journal of Anaesthesia. Vol.126, No.6 (2021), 1111-1118
Suggested Citation
Matthew B.A. Harmon, Nanon F.L. Heijnen, Sanne de Bruin, Niek H. Sperna Weiland, Joost C.M. Meijers, Anita M. de Boer, Marcus J. Schultz, Janneke Horn, Nicole P. Juffermans Induced normothermia ameliorates the procoagulant host response in human endotoxaemia. British Journal of Anaesthesia. Vol.126, No.6 (2021), 1111-1118. doi:10.1016/j.bja.2021.02.033 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78170
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Title
Induced normothermia ameliorates the procoagulant host response in human endotoxaemia
Abstract
Background: Dysregulation of coagulation occurs commonly in sepsis, ranging from mild coagulopathy with decreased platelets to disseminated intravascular coagulation (DIC). We investigated the effect of induced normothermia on coagulation during lipopolysaccharide (LPS)-induced endotoxaemia in healthy volunteers. Methods: Twelve volunteers received an infusion of bacterial lipopolysaccharide (Escherichia coli; 2 ng kg−1) and were assigned to either induced normothermia or control. Induced normothermia to maintain core temperature at 37°C consisted of external surface cooling, cold i.v. fluids, and medication to reduce shivering (buspirone, clonidine, and magnesium sulphate). The primary outcome was the DIC score (International Society on Thrombosis and Haemostasis guideline). Prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, plasma von Willebrand factor (vWf), and rotational thromboelastometry (ROTEM) were measured before and 1, 3, 6, and 8 h after LPS infusion. Differences between groups were tested with a mixed effects model. Results: In control subjects, lipopolysaccharide caused a fever, transiently decreased platelet levels and lowered activated partial thromboplastin time, while prolonging prothrombin time and increasing D-Dimer and vWf levels. Normothermia prevented the DIC-score exceeding 4, which occurred in 50% of control subjects. Normothermia also reduced the fall in platelet count by 67x109 L−1([95%CI:27-107]; p=0.002), aPTT (mean difference:3s [95%CI:1-5]; p=0.005) and lowered vWf levels by 89% ([95%CI:6-172]; p=0.03), compared to the fever group. ROTEM measurements were unaffected by lipopolysaccharide. Conclusion: In human endotoxaemia, induced normothermia decreases markers of endothelial activation and DIC. Maintaining normothermia may reduce coagulopathy in hyperinflammatory states.