Sepsis-associated Purpura fulminans in adults

Sepsis-associated purpura fulminans is defined as septicemia, shock, dissem inated intravascular coagulation and circulatory failure leading to multipl e organ dysfunction. 40-70% of patients with sepsis-associated purpura fulm inans die. Early prognostic factors in adults have not been well delineated yet. Aim of our study was 1) to evaluate currently used scoring systems for meni ngococcal septicemia in the setting of sepsis-associated purpura fulminans and 2) to assess if other parameters are feasible as early prognostic facto rs. From 1. 1 1994-31. 12.1998 twelve patients (female: 7; mean age: 31 (21;43) years) were studied. Six patients (50%) died within 2 hours and 7 days aft er admission despite standard intensive treatment. On admission non-survivors had a more pronounced degree of disseminated int ravascular coagulation compared to survivors (platelet count 18000 (15000; 45000)G/l vs. 119.000 1111000; 152000)G/l, (p=0.03); fibrinogen 67 (50; 108 ) mg/dl vs. 356 (234; 483)mg/dl, (p = 0.02); PTZ 28% (20%; 30%) vs.44% (35% ; 51%), (p = 0.05), aPTT 120 (120; 128) sec vs. 46 (44; 69)sec, (p = 0.001) . Severity of lactic acidosis was significantly higher in non-survivors tha n in survivors (pH 7.08 (6.92; 7.21) vs, pH 7.4 (7.25; 7.4), (p = 0.02); la ctate 13.5 (11; 15)mval/l vs. 6.0 (4.4; 6) mval/l, (p = 0,02); data present ed as median (25-75% interquartile range). In our patients the Glasgow Meningococcal Septicemia Prognostic Score (GMSP S) and the Niklasson-Score failed to distinguish between survivors and non- survivors (GMSPS 7 (6; 11) vs 7.5 (7; 9) out of 15; predicted mortality acc ording to Niklasson-Score 73% vs 88%). There was no difference in the APACH E II Score (22 (18,5, 24) vs 22 (20.25, 26)). The severity of disseminated intravascular coagulation assessed by routine laboratory parameters and the degree of lactic acidosis on admission were t he strongest predictors of outcome in patients with sepsis-associated purpu ra fulminans. Scoring systems developed for patients with meningococcal sep ticemia are of limited value in the setting of sepsis-associated purpura fu lminans.