Sepsis-Associated Coagulopathy Predicts Hospital Mortality in Critically Ill Patients With Postoperative Sepsis

Chao Ren; Yu-Xuan Li; De-Meng Xia; Peng-Yue Zhao; Sheng-Yu Zhu; Li-Yu Zheng; Li-Ping Liang; Ren-Qi Yao; Xiao-Hui Du

doi:10.3389/fmed.2022.783234

Sepsis-Associated Coagulopathy Predicts Hospital Mortality in Critically Ill Patients With Postoperative Sepsis

Front Med (Lausanne). 2022 Feb 15:9:783234. doi: 10.3389/fmed.2022.783234. eCollection 2022.

Authors

Chao Ren^{1

2}, Yu-Xuan Li^{1

3}, De-Meng Xia^{4

5}, Peng-Yue Zhao^{1

3}, Sheng-Yu Zhu³, Li-Yu Zheng¹, Li-Ping Liang⁶, Ren-Qi Yao^{1

7}, Xiao-Hui Du³

Affiliations

¹ Translational Medicine Research Center, Fourth Medical Center and Medical Innovation Research Division of the Chinese PLA General Hospital, Beijing, China.
² Department of Pulmonary and Critical Care Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
³ Department of General Surgery, First Medical Center of the Chinese PLA General Hospital, Beijing, China.
⁴ Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China.
⁵ Department of Orthopedics, The Naval Hospital of Eastern Theater Command of People's Liberation Army of China, Zhoushan, China.
⁶ Guangmingqiao Clinic, East Beijing Medical Area of the Chinese PLA General Hospital, Beijing, China.
⁷ Department of Burn Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.

Abstract

Background: The incidence of coagulopathy, which was responsible for poor outcomes, was commonly seen among patients with sepsis. In the current study, we aim to determine whether the presence of sepsis-associated coagulopathy (SAC) predicts the clinical outcomes among critically ill patients with postoperative sepsis.

Methods: We conducted a single-center retrospective cohort study by including patients with sepsis admitted to surgical ICU of Chinese PLA General Hospital from January 1, 2014 to December 31, 2018. Baseline characteristics and clinical outcomes were compared with respect to the presence of SAC. Kaplan-Meier analysis was applied to calculate survival rate, and Log-rank test was carried out to compare the differences between two groups. Furthermore, multivariable Cox and logistic and linear regression analysis were performed to assess the relationship between SAC and clinical outcomes, including hospital mortality, development of septic shock, and length of hospital stay (LOS), respectively. Additionally, both sensitivity and subgroup analyses were performed to further testify the robustness of our findings.

Results: A total of 175 patients were included in the current study. Among all included patients, 41.1% (72/175) ICU patients were identified as having SAC. In-hospital mortality rates were significantly higher in the SAC group when compared to that of the No SAC group (37.5% vs. 11.7%; p < 0.001). By performing univariable and multivariable regression analyses, presence of SAC was demonstrated to significantly correlate with an increased in-hospital mortality for patients with sepsis in surgical ICU [Hazard ratio (HR), 3.75; 95% Confidence interval (CI), 1.90-7.40; p < 0.001]. Meanwhile, a complication of SAC was found to be the independent predictor of the development of septic shock [Odds ratio (OR), 4.11; 95% CI, 1.81-9.32; p = 0.001], whereas it was not significantly associated with prolonged hospital LOS (OR, 0.97; 95% CI, 0.83-1.14; p = 0.743).

Conclusion: The presence of SAC was significantly associated with increased risk of in-hospital death and septic shock among postoperative patients with sepsis admitted to ICU. Moreover, there was no statistical difference of hospital LOS between the SAC and no SAC groups.

Keywords: coagulopathy; intensive care unit; mortality; postoperative; sepsis.