Role of international normalized ratio in nonpulmonary sepsis screening: An observational study

Jing Zhang; Hui-Min Du; Ming-Xiang Cheng; Fa-Ming He; Bai-Lin Niu

doi:10.12998/wjcc.v9.i25.7405

Role of international normalized ratio in nonpulmonary sepsis screening: An observational study

World J Clin Cases. 2021 Sep 6;9(25):7405-7416. doi: 10.12998/wjcc.v9.i25.7405.

Authors

Jing Zhang¹, Hui-Min Du², Ming-Xiang Cheng³, Fa-Ming He¹, Bai-Lin Niu⁴

Affiliations

¹ Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
² Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
³ Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
⁴ Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. nberlin@126.com.

Abstract

Background: Currently, there is a lack of sepsis screening tools that can be widely used worldwide. Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms, which usually rely less on screening tools.

Aim: To investigate the efficiency of the international normalized ratio (INR) for the early rapid recognition of adult nonpulmonary infectious sepsis.

Methods: This is a prospective observational study. A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria. Commonly used clinical indicators, such as white blood cell, neutrophil count, lymphocyte count, neutrophil-lymphocyte count ratio (NLCR), platelets (PLT), prothrombin time, INR, activated partial thromboplastin time, and quick Sequential "Sepsis-related" Organ Failure Assessment (qSOFA) scores were recorded within 24 h after admission. The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis, Spearman correlation, and receiver operating characteristic curve analysis.

Results: The INR value of the sepsis group was significantly higher than that of the nonsepsis group. INR has superior diagnostic efficacy for sepsis, with an area under the curve value of 0.918, when those preexisting diseases which significantly affect coagulation function were excluded. The diagnostic efficacy of the INR was more significant than that of NLCR, PLT, and qSOFA (P < 0.05). Moreover, INR levels of 1.17, 1.20, and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories: low, medium and high risk, respectively.

Conclusion: The INR is a promising and easily available biomarker for diagnosis, and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis. When its value is higher than the optimal cutoff value (1.22), high vigilance is required for adult nonpulmonary infectious sepsis.

Keywords: Coagulopathy; International normalized ratio; Quick Sequential “Sepsis-related” Organ Failure Assessment; Screening tool; Sepsis.