Evaluation of tissue factor expression on monocytes in the patients with sepsis

Sepsis is nearly always associated with some type of haemostatic disorder. The factors that play main causal role in pathogenesis of these processes are pro-inflammatory cytokines, vascular endothelium, platelets, leukocytes, and tissue factor (TF) expressed on these cells, which is always in an active state. Given a potential relationship between the blood clotting and pathophysiology of sepsis, TF may be considered a biomarker for early diagnosis, risk stratification, and prognosis of disease outcome in sepsis. Objective – to study quantitative content (CD14+CD142+) and the levels of TF expression on monocytes in the patients with sepsis, to analyze the dependence of these parameters on the severity of multiple organ dysfunction according to the SOFA scale, and disease outcomes.
67 patients with sepsis were examined. The severity of multiple organ dysfunction/failure was assessed by means of the SOFA score (Sepsis-related Organ Failure Assessments, Sequential Organ Failure Assessment). All the patients were divided in 2 groups based on the severity of their condition and extent of organ failure. Group 1 (n = 30) included the patients diagnosed with sepsis and severe organ dysfunction of < 6 points on the SOFA scale; Group 2 (n = 37) consisted of the patients with sepsis and organ dysfunction of > 6 points according to the SOFA scores. Blood sampling from patients was made within initial 48 hours after admission and diagnosis. Quantitative content (CD14+CD142+) and the level of expression of tissue factor on monocytes were investigated by flow cytometry. We have found that the content of (CD14+CD142+) cells was significantly higher in patients with sepsis than in healthy individuals (6.03±1.05% vs 0.24±0.02%, p = 0.001), being higher in more severe organ dysfunction (SOFA) vs less severe cases (SOFA) (6.50±0.98% versus 4.42±0.36%, p = 0.05). High level of TF expression on monocytes showed a direct correlation (r > 0.71; p = 0.05) with severity of organ dysfunction (SOFA), and it was associated (p = 0.004) with lethal outcome of the disorder. These results suggest that expression of tissue factor on monocytes can serve as a biomarker reflecting the degree of systemic inflammation in sepsis, thus being a criterion for predicting clinical severity and outcome of the disease in patients with sepsis.