Retrospective analysis of von willebrand factor and microthrombus formation in septic shock: associations with TTP-like syndrome and sepsis-induced coagulopathy.

objectiveSepsis shock is characterized by endothelial damage and coagulation abnormalities. However, the relationship between von Willebrand factor (vWF), microthrombosis, and various clinical phenotypes such as thrombotic thrombocytopenic purpura (TTP) and sepsis-induced coagulopathy (SIC) has not been fully elucidated.

methodsThis retrospective study enrolled 147 patients with septic shock admitted to the ICU in 2023, all of whom underwent vWF antigen testing. The patients were divided into three groups: the TTP-like group, the SIC group, and the control group. Platelet (PLT) indices, vWF levels, SOFA subscores, incidence of organ dysfunction, and 28-day mortality were compared. Correlation analyses and non-parametric tests were performed.

resultsThe SIC group showed significantly lower nadir PLT counts and higher PLT decline rates compared with the TTP-like and control groups (P < 0.05). vWF levels were elevated across all groups and were significantly higher in the TTP-like and SIC groups versus controls (P < 0.05). vWF levels correlated negatively with nadir PLT (r = -0.20, P = 0.018). Both TTP-like syndrome and SIC were associated with high rates of MODS; however, hepatic and renal injury, number of dysfunctional organs, and 28-day mortality were significantly worse in the SIC group (P < 0.05).

conclusionElevated vWF is associated with diffuse microthrombus formation in septic shock and may serve as a marker of endothelial injury. While both TTP-like syndrome and SIC contribute to organ dysfunction, SIC is associated with more severe organ injury and higher mortality. Prospective studies are needed to validate these findings.