New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey

Abstract

Objective: Recent clinical studies have shown that anticoagulant therapy might be effective only in specific at-risk subgroups of patients with sepsis and coagulation dysfunction. The definition of sepsis was recently modified, and as such, old scoring systems may no longer be appropriate for the diagnosis of sepsis-associated coagulopathy. The aim of this study was to evaluate prognostic factors in patients diagnosed with sepsis and coagulopathy according to the new sepsis definition and assess their accuracy in comparison with existing models.

Design: Retrospective analysis of the nationwide survey for recombinant human soluble thrombomodulin.

Setting: General emergency and critical care centres in secondary and tertiary care hospitals.

Participants: We evaluated the prognostic value of the newly proposed diagnostic criteria for sepsis-induced coagulopathy (SIC). A total of 1498 Japanese patients with sepsis and coagulopathy complications who were treated with recombinant thrombomodulin were analysed in this study.

Main outcome measures: The platelet count, prothrombin time (PT) ratio, fibrinogen/fibrin degradation products, systemic inflammatory response syndrome score and Sequential Organ Failure Assessment (SOFA) score obtained just before the start of treatment were examined in relation to the 28-day mortality rate.

Results: The platelet count, PT ratio and total SOFA were independent predictors of a fatal outcome in a logistic regression model. A SIC score was defined using the three above-mentioned variables with a positivity threshold of 4 points or more. The SIC score predicted higher 28-day mortality rate compared with the current Japanese Association for Acute Medicine-disseminated intravascular coagulation score (38.4%vs34.7%).

Conclusion: The SIC score is based on readily available parameters, is easy to calculate and has a high predictive value for 28-day mortality. Future studies are warranted to evaluate whether the SIC score may guide the decision to initiate anticoagulant therapy.

Keywords: disseminated intravascular coagulation; platelet count; prothrombin time; sepsis; thrombomodulin.

Figure 1

Patient counts and mortality rates according to platelet count, prothrombin time ratio and total Sequential Organ Failure Assessment (SOFA) score. The bar graph shows the number of patients in each category, and the line graph represents the mortality rate. The x-axis represents the score and (case number). A: many of the patients had an initial platelet count of 100×10⁹/L or less. Mortality increased to 35% when the count decreased to less than 100×10⁹/L. B: mortality increased along with an increase in the prothrombin time ratio, reaching more than 40% when the prothrombin time ratio was more than 1.4. C: the population of total SOFA score of 0 and 1 is quite limited, and the mortality of this population was lower than that of the score of 2 or more.

Figure 2

Patient counts and mortality rates according to the SIC and the JAAM-DIC classifications. The patient distributions (bars) and the mortality rates (lines) are plotted according to the SIC scores (left) and the JAAM-DIC scores (right). The x-axis represents the score and (case number). The mortality rate increased as SIC score elevated and exceeded 20% at a score of 4. In contrast, the mortality rate exceeded 30% at a JAAM-DIC score of 4 and gradually increased to 40%. DIC, disseminated intravascular coagulation; JAAM, Japanese Association for Acute Medicine; SIC, sepsis-induced coagulopathy.