Risk factors and incidence of sepsis-induced coagulopathy in patients with sepsis: a single- center retrospective cohort study

Abstract

Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection which poses a significant threat to the survival of patients admitted to the intensive care unit (ICU). Sepsis-induced coagulopathy (SIC) is a serious complication of sepsis which often leads to multiple organ dysfunction syndrome (MODS) and poor prognosis. So far, there is almost no research to clarify the risk factors for the occurrence of SIC and the reports about incidence of SIC are not very consistent. Methods: A retrospective cohort study was conducted in an ICU of a tertiary general hospital to identify risk factors for SIC and provide evidence for early diagnosis and treatment of SIC. All enrolled patients were divided into SIC group and non-SIC group according to whether the SIC score was greater than 4. The primary outcome was risk factors of SIC. Secondary outcomes included incidence and clinical outcomes of SIC. Clinical outcomes contained continuous renal replacement therapy(CRRT) proportion, mechanical ventilation days, length of ICU stay, ICU mortality, 28-day mortality and critical bleeding events. Binary logistic regression analysis was used to evaluate the independent risk factors for SIC. Results: A total of 254 patients were enrolled in the study. 122 patients were assigned into the SIC group, whereas 132 patients were assigned into the non-SIC group. Binary logistic regression analysis of independent risk factors for SIC showed that high Sequential Organ Failure Assessment (SOFA) score(OR=1.186,95%CI 1.028-1.37,P=0.2), high total bilirubin (OR=1.036,95%CI 1.012-1.062,P=0.004), high lactate (OR=1.238,95%CI 1.009-1.518,P=0.041) , low platelet (OR=0.991,95%CI 0.986-0.995,P<0.001) and high international normalized ratio (INR) (OR=1775.247,95%CI 14.808-212822.214,P=0.002) were independent risk factors for SIC. While age, Acute Physiology and Chronic Health Evaluation (APACHE) II, diabetes mellitus, blood infection, procalcitonin, C-reactive protein, creatinine, fibrinogen, prothrombin time and D-Dimer were not independent risk factors for SIC(P>0.05). The secondary outcome demonstrated that the incidence of SIC was about 48.0% in patients with sepsis. In addition, the 28-day mortality of SIC patients was 46.7%(57/122) and the one of non-SIC patients was 45.5%(60/132), the 28-day mortality was not statistically significant between two groups(P=0.84). The ICU mortality(P=0.942), mechanical ventilation days(P=0.209), ICU length of stay(P=0.344) and critical bleeding events(P=0.516) all had no statistical differences between two groups(P>0.05). The CRRT proportion of SIC group was 30.3%(37/122) and the one of non-SIC group was 15.2%(20/132), The CRRT proportion of SIC group was higher than that of non-SIC group(P=0.004). Conclusions: High SOFA score, low platelet, high INR, high bilirubin and high lactate are independent risk factors for SIC. The incidence of SIC is about 48.0% in patients with sepsis and the 28-day mortality of SIC patients is about 46.7%. The CRRT proportion of SIC group is higher than that of non-SIC group. Clinicians should be highly alert to the abnormalities of the above risk factors when patients are admitted to hospital, and pay more attention to septic patients with these abnormal indicators.