Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation

doi:10.5847/wjem.j.1920-8642.2024.041

Abstract

Abstract:

BACKGROUND: Disseminated intravascular coagulation (DIC) is associated with increased mortality in sepsis patients. In this study, we aimed to assess the clinical ability of sepsis-induced coagulopathy (SIC) and sepsis-associated coagulopathy (SAC) criteria in identifying overt-DIC and pre-DIC status in sepsis patients.
METHODS: Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022. The performances of the SIC and SAC were assessed to identify overt-DIC on days 1, 3, 7, or 14. The SIC status or SIC score on day 1, the SAC status or SAC score on day 1, and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC. The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.
RESULTS: On day 1, the incidences of coagulopathy according to overt-DIC, SIC and SAC criteria were 11.7%, 22.0% and 31.5%, respectively. The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14 (P<0.05). On day 1, the SIC score with a cut-off value > 3 had a significantly higher sensitivity (72.00%) and area under the curve (AUC) (0.69) in identifying pre-DIC than did the SIC or SAC status (sensitivity: SIC status 44.00%, SAC status 52.00%; AUC: SIC status 0.62, SAC status 0.61). The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC (0.79 vs. 0.69, P<0.001). Favorable effects of anticoagulant therapy were observed in SIC (adjusted hazard ratio [HR]=0.216, 95% confidence interval [95% CI]: 0.060-0.783, P=0.018) and SAC (adjusted HR=0.146, 95% CI: 0.041-0.513, P=0.003).
CONCLUSION: The SIC and SAC seem to be valuable for predicting overt-DIC. The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.

Key words: Sepsis, Disseminated intravascular coagulation, Sepsis-induced coagulopathy, Sepsis-associated coagulopathy

Huixin Zhao, Yiming Dong, Sijia Wang, Jiayuan Shen, Zhenju Song, Mingming Xue, Mian Shao. Comparison between sepsis-induced coagulopathy and sepsis-associated coagulopathy criteria in identifying sepsis-associated disseminated intravascular coagulation[J]. World Journal of Emergency Medicine, 2024, 15(3): 190-196.

Figures/Tables 6

Table 1.

Table 2.

Figure 1.

Table 3.

Table 4.

Figure 2.

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Items	Point	Overt-DIC	SIC
Platelet, ×10⁹/L	0	>100	≥150
	1	50-100	≥100, < 150
	2	<50	<100
Prolonged PT/INR, s	0	<3	≤1.2
	1	3-6	>1.2, ≤ 1.4
	2	>6	>1.4
Fibrinogen, g/mL	0	≥100	-
Fibrinogen, g/mL	1	<100	-
D-dimer ^a	0	Normal	-
	2	Moderate increase	-
	3	Severe increase	-
SOFA score ^b	0	-	0
	1	-	1
	2	-	≥2
Diagnosis		≥5 points	≥4 points ^c

INR	PLT (×10⁹/L)
INR	≥150	100-149	80-99	<80
<1.2	No SAC	No SAC	No SAC	No SAC
≥1.2, <1.4	No SAC	Mild SAC	Moderate SAC	Moderate SAC
≥1.4, <1.6	No SAC	Moderate SAC	Moderate SAC	Moderate SAC
≥1.6	No SAC	Moderate SAC	Moderate SAC	Severe SAC

Time	SIC	SAC	P-value
Day 1
Prevalence, %	22.0 (92/419)	31.5 (132/419)	<0.001
AUC (95% CI)	0.85 (0.81-0.88)	0.83 (0.79-0.87)	0.307
Sensitivity, %	83.67	89.80	0.250
Specificity, %	86.22	76.22	<0.001
PPV, %	44.6	33.3	0.088
NPV, %	97.6	98.3	0.545
Day 3
Prevalence, %	14.1 (59/419)	20.8 (87/419)	<0.001
AUC (95% CI)	0.84 (0.80-0.87)	0.81 (0.77-0.85)	0.097
Sensitivity, %	75.00	77.50	1.000
Specificity, %	92.16	84.86	<0.001
PPV, %	50.8	35.6	0.067
NPV, %	97.2	97.2	0.957
Day 7
Prevalence, %	10.3 (42/409)	14.4 (59/409)	<0.001
AUC (95% CI)	0.86 (0.82-0.90)	0.89 (0.85-0.92)	0.422
Sensitivity, %	80.00	90.00	0.500
Specificity, %	92.40	88.18	<0.001
PPV, %	38.1	30.5	0.426
NPV, %	98.7	99.4	0.725
Day 14
Prevalence, %	5.7 (22/389)	7.5 (29/389)	0.016
AUC (95% CI)	0.93 (0.89-0.96)	0.91 (0.87-0.95)	0.007
Sensitivity, %	90.91	90.91	1.000
Specificity, %	94.69	91.59	0.016
PPV, %	45.5	34.5	0.128
NPV, %	99.5	99.5	0.539

Criteria	AUC	95% CI	Cut-off value	Sensitivity	Specificity	PPV	NPV
SIC criteria	0.62^*	0.57-0.66	-	44.00%	79.44%	12.0%	95.7%
SAC criteria	0.61^*	0.56-0.67	-	52.00%	69.80%	9.8%	95.8%
SIC score on day 1	0.69^*	0.65-0.74	>3	72.00%	62.94%	11.0%	97.3%
SAC rating	0.61^*	0.57-0.66	> 0	52.00%	69.80%	9.8%	95.8%

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