Coagulopathy Parameters Predictive of Outcomes in Sepsis-induced Acute Respiratory Distress Syndrome: A Sub-Analysis of the Two Prospective Multicenter Cohort Studies

Abstract

Background Although coagulopathy is often observed in acute respiratory distress syndrome (ARDS), its clinical impact remains poorly understood. Objectives This study aimed to clarify the coagulopathy parameters that are clinically applicable for prognostication and to determine anticoagulant indications in sepsis-induced ARDS. Method This study enrolled patients with sepsis-derived ARDS from two nationwide multicenter, prospective observational studies. We explored coagulopathy parameters that could predict outcomes in the FORECAST cohort, and the defined coagulopathy criteria were validated in the SPICE-ICU cohort. The correlation between anticoagulant use and outcomes was also evaluated. Results A total of 181 patients with sepsis-derived ARDS in the FORECAST study and 61 patients in the SPICE-ICU study were included. In a preliminary study, we found the set of PT-INR ≥1.4 and platelets ≤12 × 104/μL, Thrombocytopenia and Elongated Prothrombin time, TEP, coagulopathy as the best coagulopathy parameters, and used for further analysis, of which odds ratio of TEP coagulopathy for in-hospital mortality adjusted for confounding was 3.84 (95% CI, 1.66–8.87; p = 0.005). In the validation cohort, the adjusted odds ratio for in-hospital mortality was 32.99 (95% CI, 2.60–418.72; p = 0.002). Although patients without TEP coagulopathy showed significant improvements in oxygenation over the first 4 days, patients with TEP coagulopathy showed no significant improvement (ΔPaO2/FiO2 ratio, 24 ± 20 vs. 90 ± 9; p = 0.026). Furthermore, anticoagulant use was significantly correlated with mortality and oxygenation recovery in patients with TEP coagulopathy but not in patients without TEP coagulopathy. Conclusion TEP coagulopathy is closely associated with better outcomes and responses to anticoagulant therapy in sepsis-induced ARDS, and our coagulopathy criteria may be clinically useful. Trial registration FORECAST study: UMIN-CTR ID: UMIN000019742. Registration date: November 11th, 2015. SPICE-ICU study: UMIN-CTR ID: UMIN000027258. Registration date: May 6th, 2017.