Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock

Schupp, Tobias; Weidner, Kathrin; Rusnak, Jonas; Jawhar, Schanas; Forner, Jan; Dulatahu, Floriana; Brück, Lea Marie; Hoffmann, Ursula; Bertsch, Thomas; Müller, Julian; Weiß, Christel; Akın, İbrahim; Behnes, Michael

doi:10.1177/10760296221137893

Cited by 12 publications

(9 citation statements)

References 33 publications

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“…In line, 55% of CS patients suffered from concomitant infection in the present study. Sepsis-induced disseminated intravascular coagulation (DIC), leading to increased PT/INR is reported to occur in 30–50% of septic patients, alongside an increased risk of all-cause mortality [27,28]; however, baseline platelet count did not differ among 30-day survivors and nonsurvivors within the present registry, which may suggest different pathophysiological patterns for PT/INR increase within the present registry than sepsis-induced DIC.…”

Section: Discussionmentioning

confidence: 72%

The prothrombin time/international normalized ratio predicts prognosis in cardiogenic shock

Schupp

Behnes

Rusnak

et al. 2023

Coronary Artery Disease

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Objective The study investigates the prognostic impact of the prothrombin time/international normalized ratio (PT/INR) in patients with cardiogenic shock. Background Despite ongoing improvements regarding the treatment of cardiogenic shock patients, intensive care unit (ICU)-related mortality in cardiogenic shock patients remains unacceptably high. Limited data regarding the prognostic value of the PT/INR during the course of cardiogenic shock treatment is available. Methods All consecutive patients with cardiogenic shock from 2019 to 2021 were included at one institution. Laboratory values were collected from the day of disease onset (day 1) and days 2, 3, 4 and 8. The prognostic impact of the PT/INR was tested for 30-day all-cause mortality, as well as the prognostic role of PT/INR changes during course of ICU hospitalization. Statistical analyses included univariable t-test, Spearman’s correlation, Kaplan–Meier analyses, C-Statistics and Cox proportional regression analyses. Results Two hundred twenty-four cardiogenic shock patients were included with a rate of all-cause mortality at 30 days of 52%. The median PT/INR on day 1 was 1.17. The PT/INR on day 1 was able to discriminate 30-day all-cause mortality in cardiogenic shock patients [area under the curve 0.618; 95% confidence interval (CI), 0.544–0.692; P = 0.002). Patients with PT/INR > 1.17 were associated with an increased risk of 30-day mortality [62% vs. 44%; hazard ratio (HR) = 1.692; 95% CI, 1.174–2.438; P = 0.005], which was still evident after multivariable adjustment (HR = 1.551; 95% CI, 1.043–2.305; P = 0.030). Furthermore, especially patients with an increment of the PT/INR by ≥10% from day 1 to day 2 were associated with an increased risk of 30-day all-cause mortality (64% vs. 42%; log-rank P = 0.014; HR = 1.833; 95% CI, 1.106–3.038; P = 0.019). Conclusion Baseline PT/INR and an increase of the PT/INR during the course of ICU treatment were associated with the risk of 30-day all-cause mortality in cardiogenic shock patients.

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Section: Discussionmentioning

confidence: 72%

The prothrombin time/international normalized ratio predicts prognosis in cardiogenic shock

Schupp

Behnes

Rusnak

et al. 2023

Coronary Artery Disease

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“…In addition, PT-INR has been proven to be an appropriate prognostic tool for 30-day all-cause mortality. PT-INR > 1.5 is associated with an increased risk of all cause death at 30 days, as observed in patients with sepsis and septic shock [29].During sepsis, the hemostatic balance is signi cantly disrupted. The coagulation process is activated, while anticoagulant mechanisms, including brinolysis and anticoagulant factors, are suppressed.…”

Section: Discussionmentioning

confidence: 94%

Risk factors and incidence of sepsis-induced coagulopathy in patients with sepsis: a single- center retrospective cohort study

Li,

Zhang,

Gao

et al. 2023

Preprint

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Background: Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection which poses a significant threat to the survival of patients admitted to the intensive care unit (ICU). Sepsis-induced coagulopathy (SIC) is a serious complication of sepsis which often leads to multiple organ dysfunction syndrome (MODS) and poor prognosis. So far, there is almost no research to clarify the risk factors for the occurrence of SIC and the reports about incidence of SIC are not very consistent. Methods: A retrospective cohort study was conducted in an ICU of a tertiary general hospital to identify risk factors for SIC and provide evidence for early diagnosis and treatment of SIC. All enrolled patients were divided into SIC group and non-SIC group according to whether the SIC score was greater than 4. The primary outcome was risk factors of SIC. Secondary outcomes included incidence and clinical outcomes of SIC. Clinical outcomes contained continuous renal replacement therapy(CRRT) proportion, mechanical ventilation days, length of ICU stay, ICU mortality, 28-day mortality and critical bleeding events. Binary logistic regression analysis was used to evaluate the independent risk factors for SIC. Results: A total of 254 patients were enrolled in the study. 122 patients were assigned into the SIC group, whereas 132 patients were assigned into the non-SIC group. Binary logistic regression analysis of independent risk factors for SIC showed that high Sequential Organ Failure Assessment (SOFA) score(OR=1.186,95%CI 1.028-1.37,P=0.2), high total bilirubin (OR=1.036,95%CI 1.012-1.062,P=0.004), high lactate (OR=1.238,95%CI 1.009-1.518,P=0.041) , low platelet (OR=0.991,95%CI 0.986-0.995,P<0.001) and high international normalized ratio (INR) (OR=1775.247,95%CI 14.808-212822.214,P=0.002) were independent risk factors for SIC. While age, Acute Physiology and Chronic Health Evaluation (APACHE) II, diabetes mellitus, blood infection, procalcitonin, C-reactive protein, creatinine, fibrinogen, prothrombin time and D-Dimer were not independent risk factors for SIC(P>0.05). The secondary outcome demonstrated that the incidence of SIC was about 48.0% in patients with sepsis. In addition, the 28-day mortality of SIC patients was 46.7%(57/122) and the one of non-SIC patients was 45.5%(60/132), the 28-day mortality was not statistically significant between two groups(P=0.84). The ICU mortality(P=0.942), mechanical ventilation days(P=0.209), ICU length of stay(P=0.344) and critical bleeding events(P=0.516) all had no statistical differences between two groups(P>0.05). The CRRT proportion of SIC group was 30.3%(37/122) and the one of non-SIC group was 15.2%(20/132), The CRRT proportion of SIC group was higher than that of non-SIC group(P=0.004). Conclusions: High SOFA score, low platelet, high INR, high bilirubin and high lactate are independent risk factors for SIC. The incidence of SIC is about 48.0% in patients with sepsis and the 28-day mortality of SIC patients is about 46.7%. The CRRT proportion of SIC group is higher than that of non-SIC group. Clinicians should be highly alert to the abnormalities of the above risk factors when patients are admitted to hospital, and pay more attention to septic patients with these abnormal indicators.

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“…In addition, INR has been proven to be an appropriate prognostic tool for 30-day all-cause mortality. INR > 1.5 is associated with an increased risk of all cause death at 30 days, as observed in patients with sepsis and septic shock [29].During sepsis, the hemostatic balance is signi cantly disrupted. The coagulation process is activated, while anticoagulant mechanisms, including brinolysis and anticoagulant factors, are suppressed.…”

Section: Discussionmentioning

confidence: 95%

Development and validation of a nomogram for predicting sepsis-induced coagulopathy in septic patients: mixed retrospective and prospective cohort study

Li,

Zhang,

Wang

et al. 2024

Preprint

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Background: Sepsis-induced coagulopathy (SIC) is a common cause of poor prognosis in critically ill patients in the intensive care unit (ICU). However, currently there are no tools specifically designed for predicting the occurrence of SIC in septic patients. This study aimed to develop a predictive nomogram incorporating clinical markers and scoring systems to individually predict the probability of SIC in septic patients. Methods: Patients consecutively recruited in the stage between January 2022 and April 2023 constituted the development cohort for retrospective analysis to internally test the nomogram, and patients in the stage between May 2023 to November 2023 constituted the validation cohort for prospective analysis to external validate the nomogram. Firstly, multivariate logistic regression analysis of the development cohort was performed using backward stepwise method to determine the best fitting model and obtain the nomogram from it. The nomogram was validated in an independent external validation cohort, involving discrimination and calibration. A decision curve analysis was also performed to evaluate the net benefit of the insertion decision with this nomogram. Results: A total of 548 and 245 patients, 55.1% and 49.4% with SIC occurrence, were included in the development and validation cohort, respectively. Predictors contained in the prediction nomogram included shock, platelets and international normalized ratio (INR). Patients with shock (OR, 4.499; 95% CI, 2.730-7.414; P < 0.001) , higher INR (OR, 349.384; 95% CI, 62.337-1958.221; P < 0.001) and lower platelet (OR, 0.985; 95% CI, 0.982-0.988; P < 0.001) had higher probabilities of SIC. The development model showed good discrimination, with an area under the receiver operating characteristic curve (AUROC) of 0.879（95%CI, 0.850-0.908）and good calibration. Application of the nomogram in the validation cohort also gave good discrimination with an AUROC of 0.872（95%CI,0.826-0.917）and good calibration. The decision curve analysis of the nomogram provided better net benefit than the alternate options (intervention or no intervention). Conclusions: By incorporating shock, platelets and INR in the model, this useful nomogram could be accessibly utilized to predict SIC occurrence in septic patients. However, external validation is still required for further generalizability improvement of this nomogram.

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Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock

Cited by 12 publications

References 33 publications

The prothrombin time/international normalized ratio predicts prognosis in cardiogenic shock

The prothrombin time/international normalized ratio predicts prognosis in cardiogenic shock

Risk factors and incidence of sepsis-induced coagulopathy in patients with sepsis: a single- center retrospective cohort study

Development and validation of a nomogram for predicting sepsis-induced coagulopathy in septic patients: mixed retrospective and prospective cohort study

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