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Open AccessArticle

Flow Cytometry-Based Quantification of Neutrophil Extracellular Traps Shows an Association with Hypercoagulation in Septic Shock and Hypocoagulation in Postsurgical Systemic Inflammation—A Proof-of-Concept Study

1
Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, Justus Liebig University of Giessen, Rudolf-Buchheim-Strasse 7, 35392 Giessen, Germany
2
German Centre for Infection Research (DZIF), Partner Site Giessen-Marburg-Langen, 35392 Giessen, Germany
3
Department of Pulmonary Medicine, University of Giessen and Marburg Lung Center (UGMLC), University Hospital of Giessen, Justus-Liebig-University of Giessen, 35392 Giessen, Germany
4
Department of Immunology and Transfusion Medicine, Langhans Street 7, 35392 Giessen, Germany
5
Department of General and Thoracic Surgery, University Hospital of Giessen, Justus-Liebig-University of Giessen, 35392 Giessen, Germany
6
Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, 35392 Giessen, Germany
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(1), 174; https://doi.org/10.3390/jcm9010174
Received: 12 December 2019 / Revised: 27 December 2019 / Accepted: 4 January 2020 / Published: 8 January 2020
(This article belongs to the Special Issue Sepsis: Current Clinical Practices and New Perspectives)
This proof-of-concept study aimed to evaluate a novel method of flow cytometry-based quantification of neutrophil extracellular traps (NETs) in septic shock patients and to identify possible interactions between the number of free-circulating NETs and alterations of the coagulatory system. Patients suffering from septic shock, a matched control group (CTRL), and patients suffering from systemic inflammation after cardiac (CABG) or major abdominal surgery (MAS) were enrolled in this prospective proof-of-concept study. Compared to the matched controls, free-circulating NETs were significantly elevated in septic shock and postsurgical patients (data are presented in median (IQR)); septic shock: (2.7 (1.9–3.9); CABG: 2.7 (2.1–3.7); MAS: 2.7 (2.1–3.9); CTRL: 1.6 (1–2); CTRL vs. septic shock: p = 0.001; CTRL vs. CABG: p < 0.001; CTRL vs. MAS: p < 0.001). NETs correlated positively with FIBTEM mean clot firmness (MCF) in septic shock patients (r = 0.37, p < 0.01) while they correlated negatively in surgical patients (CABG: r = −0.28, p < 0.01; MAS: r = −0.25, p = 0.03). Flow-cytometric quantification of NETs showed a significant increase in free-circulating NETs under inflammatory conditions. Furthermore, this study hints to an association of the number of NETs with hypercoagulation in septic shock patients and hypocoagulation in surgery-induced inflammation.
Keywords: inflammation; sepsis; coagulopathy; cardiopulmonary bypass; major abdominal surgery inflammation; sepsis; coagulopathy; cardiopulmonary bypass; major abdominal surgery
MDPI and ACS Style

Schneck, E.; Mallek, F.; Schiederich, J.; Kramer, E.; Markmann, M.; Hecker, M.; Sommer, N.; Weissmann, N.; Pak, O.; Michel, G.; Hecker, A.; Padberg, W.; Boening, A.; Sander, M.; Koch, C. Flow Cytometry-Based Quantification of Neutrophil Extracellular Traps Shows an Association with Hypercoagulation in Septic Shock and Hypocoagulation in Postsurgical Systemic Inflammation—A Proof-of-Concept Study. J. Clin. Med. 2020, 9, 174.

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