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Introduction: Sepsis is a Systemic Inflammation Response to Infection.SIRS increases the production of cytokines,leading to a procoagulant state.This coagulopathy combines 3 mechanisms:Activation of the coagulation system;Decrease of physiologic anticoagulants;Inhibition of fibrinolysis.Severe Sepsis(SS)is associated with acute organ dysfunction. Hypothesis: Hemodynamic instability is the main cause of organ failure during an episode of SS;but fibrin deposition and formation of thrombi in the microvasculature may disrupt blood flow to vital organs,and cause Multiple Organ Failure(MOF). Methods: 68 patients admitted to the ICU with a diagnosis of Sepsis were screened for these variables:1)All-cause mortality during hospital stay;2)Number of Organs showing an acute Dysfunction(NOD);3)Serial values of platelets,PT,D-Dimers,fibrinogen,Protein-C(PC),Antithrombin-III(AT);4)Calculation of our novel Hemostatic Score(HS):Platelets >100(0 point),50-100(1),< 50(2);Increase of PT(in seconds):< 3(0),3-6(1),>6(2);D-Dimers=N(0),>N(2),>5 times the upper limit of N(3);PC=N(0), 0.50 Un/l(1),< 0.50(2);AT=N(0),< N but >0.50 Un/l(1),< 0.50(2). Results: All-cause mortality during hospital stay was 53%(36/68).Most patients(97%)developed SS(66/68).Among the 36 patients who died, there was an average of 5.6NOD,with a mean calculated HS of 8.7 points.Among the 47% of survivors(32/68),there was an average of 3.3NOD,with a mean HS of 7.0 points.Patients with a NOD< or =2 showed a mortality of 0%(0/11),with a mean HS of 5.8 points.Patients with SS and a NOD> or =3 showed a mortality of 63%(36/57),with a mean HS of 8.3 points. Conclusions: The International Society on Thrombosis and Hemostasis developed a scoring system to identify DIC.This algorithm considers the activation of hemostasis and coagulation(platelets, PT,fibrinogen),the anomalies of fibrinolysis(D-Dimers),but not the decrease of natural anticoagulants.By adding both PC and AT to our novel HS,the latter pathophysiologic mechanism is taken into account.An Acute Hematologic Dysfunction,as seen in SS,with the formation of microthrombi,leads to a significant perfusion deficit to vital organs.The data show a link between our novel HS,the NOD,the risk of developing MOF,and rate of death.

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