Pathogenesis of DIC in sepsis

Sepsis can be associated with profound alterations in the hemostatic mechanism. In this article we discuss recent insights into which mediators are involved in the activation of the coagulation system. We focus on studies performed in healthy humans intravenously injected with a low dose of endotoxin, and investigations in nonhuman primates infused with either endotoxin or live gram-negative bacteria. Special emphasis is given to the role of cytokines, in particular tumor necrosis factor-α, interleukin (IL)- 1, IL-6, IL-10 and IL-12. Moreover, the roles of tissue factor, activated protein C, and the fibrinolytic system are briefly addressed. Disseminated intravascular coagulation likely is the result of complex interactions between several host mediator systems.