Sepsis-Associated Coagulopathy Severity Predicts Hospital Mortality*

Lyons, Patrick G.; Micek, Scott T.; Hampton, Nicholas; Kollef, Marin H.

doi:10.1097/ccm.0000000000002997

Cited by 108 publications

(127 citation statements)

References 26 publications

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“…16 Recently, sepsis-associated coagulopathy has been reported to affect prognosis, that is, platelet count and PTinternational normalized ratio can predict sepsis-associated coagulopathy. 17 In our study, the platelet count was Fig. 3.…”

Section: Platelet Countmentioning

confidence: 51%

“…Thrombocytopenia in ICU patients is considered multifactorial, involving factors relating to the destruction of platelet in the peripheral blood, such as a decrease in production within the bone marrow, and abnormality in distribution; 15 however, the mechanism of thrombocytopenia due to sepsis is still unclear. 17 In our study, the platelet count was Fig. 16 Recently, sepsis-associated coagulopathy has been reported to affect prognosis, that is, platelet count and PTinternational normalized ratio can predict sepsis-associated coagulopathy.…”

Section: Platelet Countmentioning

confidence: 53%

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An evaluation of clinical inflammatory and coagulation markers in patients with sepsis: a pilot study

Fujii

Fujino

Eguchi

2019

Acute Medicine & Surgery

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Aim Presepsin values could assist early diagnosis and prognosis of sepsis. In sepsis, prognosis is determined according to multiple organ dysfunction, where coagulopathy is common and associated with prognosis. This study aimed to determine the correlation between presepsin value trend and prognosis, and investigate coagulation abnormality in sepsis. Methods We retrospectively examined 18 intensive care unit patients diagnosed with sepsis whose presepsin values at admission were ≥500 ng/mL. If presepsin values had decreased ≥50% on hospital day 6, compared to admission values, the patient was allocated into a decreased presepsin group. Results Presepsin values in non‐survivors with sepsis were significantly higher than in survivors on day 6 (P = 0.022). No significant differences in procalcitonin or C‐reactive protein were identified between survivors and non‐survivors, and platelet counts were significantly lower in non‐survivors on days 0, 3, and 6 (P = 0.001, P < 0.001, and P = 0.001, respectively). The 90‐day mortality rate in a decreased presepsin group significantly improved, even when presepsin values were high on admission (P = 0.012). Platelet counts were significantly lower on all hospital days in the non‐decreased presepsin group. Conclusion Fifty percent decrease in presepsin levels could be a useful prognostic predictor of sepsis. Larger studies are required to confirm our findings.

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Section: Platelet Countmentioning

confidence: 51%

Section: Platelet Countmentioning

confidence: 53%

An evaluation of clinical inflammatory and coagulation markers in patients with sepsis: a pilot study

Fujii

Fujino

Eguchi

2019

Acute Medicine & Surgery

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“…Sepsis survivors often develop long‐term disabilities with significant health care and social implications . Among all patients with sepsis, those who develop coagulopathy are at higher risk of death . Although there has been tremendous progress in the understanding of pathogenesis of septic coagulopathy, efforts to combat the scourge of sepsis‐associated coagulopathy have largely been unsuccessful …”

mentioning

confidence: 99%

“…1 Among all patients with sepsis, those who develop coagulopathy are at higher risk of death. 2 Although there has been tremendous progress in the understanding of pathogenesis of septic coagulopathy, efforts to combat the scourge of sepsis-associated coagulopathy have largely been unsuccessful. 2 Excessive and dysregulated thrombin generation is considered the pivotal mechanism underlying septic coagulopathy.…”

mentioning

confidence: 99%

“…2 Although there has been tremendous progress in the understanding of pathogenesis of septic coagulopathy, efforts to combat the scourge of sepsis-associated coagulopathy have largely been unsuccessful. 2 Excessive and dysregulated thrombin generation is considered the pivotal mechanism underlying septic coagulopathy. 3 More recent studies have highlighted the bidirectional relationship between thrombosis and immune mechanisms as well (termed immunothrombosis).…”

mentioning

confidence: 99%

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Managing sepsis‐associated coagulopathy remains an enigma

Thachil

2019

Journal of Thrombosis and Haemostasis

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Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy

Vincent

François

Zabolotskikh

et al. 2019

JAMA

261

246

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Previous research suggested that soluble human recombinant thrombomodulin may reduce mortality among patients with sepsis-associated coagulopathy. OBJECTIVE To determine the effect of human recombinant thrombomodulin vs placebo on 28-day all-cause mortality among patients with sepsis-associated coagulopathy. DESIGN, SETTING, AND PARTICIPANTS The SCARLET trial was a randomized, double-blind, placebo-controlled, multinational, multicenter phase 3 study conducted in intensive care units at 159 sites in 26 countries. All adult patients admitted to one of the participating intensive care units between October 2012 and March 2018 with sepsis-associated coagulopathy and concomitant cardiovascular and/or respiratory failure, defined as an international normalized ratio greater than 1.40 without other known etiology and a platelet count in the range of 30 to 150 × 10 9 /L or a greater than 30% decrease in platelet count within 24 hours, were considered for inclusion. The final date of follow-up was February 28, 2019. INTERVENTIONS Patients with sepsis-associated coagulopathy were randomized and treated with an intravenous bolus or a 15-minute infusion of thrombomodulin (0.06 mg/kg/d [maximum, 6 mg/d]; n = 395) or matching placebo (n = 405) once daily for 6 days. MAIN OUTCOME AND MEASURES The primary end point was 28-day all-cause mortality. RESULTS Among 816 randomized patients, 800 (mean age, 60.7 years; 437 [54.6%] men) completed the study and were included in the full analysis set. In these patients, the 28-day all-cause mortality rate was not statistically significantly different between the thrombomodulin group and the placebo group (106 of 395 patients [26.8%] vs 119 of 405 patients [29.4%], respectively; P = .32). The absolute risk difference was 2.55% (95% CI, −3.68% to 8.77%). The incidence of serious major bleeding adverse events (defined as any intracranial hemorrhage; life-threatening bleeding; or bleeding event classified as serious by the investigator, with administration of at least 1440 mL [typically 6 units] of packed red blood cells over 2 consecutive days) was 23 of 396 patients (5.8%) in the thrombomodulin group and 16 of 404 (4.0%) in the placebo group. CONCLUSIONS AND RELEVANCE Among patients with sepsis-associated coagulopathy, administration of a human recombinant thrombomodulin, compared with placebo, did not significantly reduce 28-day all-cause mortality.

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Sepsis-Associated Coagulopathy Severity Predicts Hospital Mortality*

Abstract: The presence of sepsis-associated coagulopathy identifies a group of patients with sepsis at higher risk for mortality. Furthermore, there is an incremental risk of mortality as the severity of sepsis-associated coagulopathy increases.

Cited by 108 publications

References 26 publications

An evaluation of clinical inflammatory and coagulation markers in patients with sepsis: a pilot study

An evaluation of clinical inflammatory and coagulation markers in patients with sepsis: a pilot study

Managing sepsis‐associated coagulopathy remains an enigma

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy

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