Angiopoietin 2 Levels in the Risk Stratification and Mortality Outcome Prediction of Sepsis-Associated Coagulopathy

Clin Appl Thromb Hemost. 2018 Nov;24(8):1223-1233. doi: 10.1177/1076029618786029. Epub 2018 Jul 11.


It has been well established that angiopoietin 2 (Ang-2), a glycoprotein involved in activation of the endothelium, plays an integral role in the pathophysiology of sepsis and many other inflammatory conditions. However, the role of Ang-2 in sepsis-associated coagulopathy (SAC) specifically has not been defined. The aim of this study was to measure Ang-2 plasma levels in patients with sepsis and suspected disseminated intravascular coagulation (DIC) in order to demonstrate its predictive value in SAC severity determination and 28-day mortality outcome. Plasma samples were collected from 102 patients with sepsis and suspected DIC at intensive care unit (ICU) admission. The Ang-2 plasma levels were quantified using a sandwich enzyme-linked immunosorbent assay method. The International Society on Thrombosis and Haemostasis DIC scoring system was used to compare the accuracy of Ang-2 levels versus clinical illness severity scores in predicting SAC severity. Mean Ang-2 levels in patients with sepsis and DIC were significantly higher in comparison to healthy controls ( P < 0.0001), and median Ang-2 levels showed a downward trend over time ( P = 0.0008). Baseline Ang-2 levels and clinical illness severity scores were higher with increasing severity of disease, and Ang-2 was a better predictor of DIC severity than clinical illness scores. This study demonstrates that Ang-2 levels are significantly upregulated in SAC, and this biomarker can be used to risk stratify patients with sepsis into non-overt DIC and overt DIC. Furthermore, the Ang-2 level at ICU admission in a patient with sepsis and suspected DIC may provide a predictive biomarker for mortality outcome.

Keywords: DIC; angiopoietin; sepsis-associated coagulopathy.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Angiopoietin-2 / blood*
  • Biomarkers / blood
  • Disease-Free Survival
  • Disseminated Intravascular Coagulation / blood*
  • Disseminated Intravascular Coagulation / etiology
  • Disseminated Intravascular Coagulation / mortality*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk Assessment
  • Sepsis / blood*
  • Sepsis / complications
  • Sepsis / mortality*
  • Survival Rate


  • ANGPT2 protein, human
  • Angiopoietin-2
  • Biomarkers