ABSTRACT
Recently, it has been increasingly apparent that sepsis and septic shock become a pressing issue. Over the last decade, incidence rate of sepsis in obstetrics and gynecology has been increased by more than 2-fold. Here we review clinical forms of septic conditions, risk factors, pathogenesis of sepsis and septic shock, as well as major pathogens resulting in septic conditions. Special attention is paid to neonatal sepsis. The relationship between septic shock and viral infections is considered in the context of the novel coronavirus infection (COVID-19) pandemic caused by SARS-CoV-2. Impaired hemostasis is discussed in patients with septic shock, including those with disseminated intravascular coagulation (DIC). An importance of assessing ADAMTS-13 level to refine disease prognosis is discussed.
ABSTRACT
The pandemic of a novel coronavirus infection COVID-19 has become a real challenge to the mankind and medical community and has raised a number of medical and social issues. Based on the currently available information on COVID-19 clinical cases, it follows that COVID-19 patients in critical condition exhibit a clinical picture of disseminated intravascular coagulation (DIC), septic shock with developing multiple organ failure, which justifies use of anticoagulant therapy in COVID-19 patients. In addition to isolating virus RNA from biological material and polymerase chain reaction diagnostics, use of simple and easily accessible laboratory blood markers is necessary for management of COVID-19 patients. If the activation of coagulation processes is sufficient enough, consumption of platelets and blood clotting factors can be diagnosed by laboratory methods as prolongation of routine blood clotting tests and increasing thrombocytopenia. Hyperfibrinogenemia, increased D-dimer level, prolonged prothrombin time, thrombocytopenia, lymphopenia, leukocytopenia, increased concentration of interleukin-6 and ferritin are observed in most COVID-19 patients. The degree of increase in these changes correlates with severity of the inflammatory process and serves as a prognostically unfavorable sign. Here we discuss value of laboratory monitoring playing an essential role in such pathological crisis that contributes to patient screening, diagnosis as well as further monitoring, treatment and rehabilitation.