Simple coagulation tests improve survival prediction in patients with septic shock

Abstract

Summary. Background: Classic mortality prediction models in intensive care units (ICUs) are based on clinical scores, which do not contain any coagulation test (SAPS-II or SOFA scores). Objectives: To determine whether coagulation tests can improve mortality prediction in patients with septic shock. Patients and methods: One hundred fifty-eight consecutive patients with septic shock entering our institutionÕs ICU were investigated on the first day of admission, and deaths were registered during the first month. Results: Among all the coagulation tests performed, only the fibrinogen (Fg) plasma level, together with the SAPS-II score and the age, were included in our simplified mortality score [area under the receiver operating curve (AUC) 0.927, standard deviation (SD) 0.030], which was more efficient than SAPS-II and SOFA scores themselves in predicting first-week mortality, its optimized cutoff having a very high negative predictive value (NPV) [0.989; 95% confidence interval (CI) 0.967-1.000)]. A simplified score predicting first-month mortality, containing the prothrombin ratio and the antithrombin activity values in addition to the age, the hemoglobin concentration, and the SAPS-II and SOFA scores (AUC 0.889, SD 0.026), was found to be superior to the SAPS-II and SOFA scores, the optimized cut-off value having a high NPV (0.952; 95% CI 0.888-1.000). Conclusions: In patients admitted to an ICU with septic shock, some initial coagulation test values can help identify those who will survive in the first week and then in the first month.

Prognostic value of hemostasis-related parameters for prediction of organ dysfunction and mortality in sepsis

“…Our study, along with a few other studies that also presented the value of hemostasis-related parameters in sepsis (8,12), implies that a revision of ICU scoring systems is needed and that coagulation markers should be part of routine monitoring of patients' clinical conditions and progression of the critical illness.…”

“…Although there are simple laboratory tests that bring insight into coagulation integrity, only a few studies have researched coagulation markers that are available in the routine hospital setting for prediction of outcome in sepsis (8,12).…”

Palifermin reduces infection rate and hyperfibrinogenemia in patients treated with high-dose chemotherapy based on beam or BU-thiothepa

“…15 Therefore, the reduction in the level of fibrinogen that we found in the group receiving palifermin substantiates the beneficial clinical effect of this agent and suggests that palifermin not only reduces the rate of infections but also may determine a reduction in risk of mortality.…”

ISTH overt disseminated intravascular coagulation score in patients with septic shock: automated immunoturbidimetric soluble fibrin assay vs. D‐dimer assay

“…The present study is the continuation of our first results from the HISS project [6], this second sub-study being focused on early FM, DDi and the related ISTH overt DIC scores values. The study was approved by our Local Ethics Committee and was conducted in our 1200-bed university hospital which contains a single 26-bed ICU.…”

“…For FRM DDi £ 0.5 mg L )1 = 0 and FM £ 5 mg L )1 = 0, according to data obtained in normal controls in our previous work [6]. The cut-off values separating moderate increases (attributed points: 2) from strong increases (attributed points: 3) were experimentally determined as the ones separating survivors from non-survivors in a plot comparing the DDi or FM centile values (Q-Q plot).…”