Article Data

  • Views 871
  • Dowloads 105

Original Research

Open Access

Sepsis-induced coagulopathy (SIC) score is an independent predictor of mortality and overt-disseminated intravascular coagulation in emergency department patients with sepsis

  • Gianluca Tullo1
  • Marcello Covino1,2
  • Luigi Carbone3,*,
  • Flavio Lo Dico2
  • Giulia Corsini2
  • Andrea Piccioni1
  • Davide Della Polla1
  • Martina Petrucci1
  • Claudio Sandroni2,4
  • Benedetta Simeoni1
  • Antonio Gasbarrini2,5
  • Francesco Franceschi1,2

1Emergency Department, Fondazione “A. Gemelli Universitary Polyclinic”, IRCCS, 00168 Rome, Italy

2Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy

3Emergency Department, Ospedale Isola Tiberina “Gemelli-Isola”, 00186 Rome, Italy

4Department of Anaesthesiology and Intensive Care Medicine—Fondazione “A. Gemelli Universitary Polyclinic”, IRCCS, 00168 Rome, Italy

5Department of Internal Medicine and Gastroenterology, Fondazione “A. Gemelli Universitary Polyclinic”, IRCCS, 00168 Rome, Italy

DOI: 10.22514/sv.2024.069 Vol.20,Issue 6,June 2024 pp.33-43

Submitted: 15 October 2023 Accepted: 28 November 2023

Published: 08 June 2024

*Corresponding Author(s): Luigi Carbone E-mail: luigi.carbone@fbf-isola.it

Abstract

Sepsis is frequently associated with coagulation anomalies which can contribute to multiple organ dysfunction and death through a mechanism of microvascular thrombosis and possible evolution to consumption coagulopathy. The recently introduced SIC (sepsis-induced coagulopathy) score was developed for the early identification of sepsis-associated coagulopathy. This study aims to evaluate the predictive value of the SIC score for in-hospital mortality and clinically significant complications in emergency department (ED) patients with sepsis. This is a retrospective, observational cohort study including patients with a diagnosis of sepsis admitted to the hospital after an ED evaluation in a period of one year (January 2021 to December 2021). The SIC score was retrospectively calculated from the electronic clinical records of our hospital. The primary outcome was in-hospital mortality; secondary outcomes were coagulopathy-related clinical complications (disseminated intravascular coagulation, bleeding, thrombosis, blood component transfusion, and organ injury). Univariate and multivariate logistic regression analyses were used to assess the association between a positive SIC score and the study endpoints. The study cohort consisted of 357 septic patients. Overall, 82 (23.0%) patients died during hospital stay, and 27 patients (7.6%) developed overt disseminated intravascular coagulation (DIC) At multivariate logistic regression analysis, a positive SIC score at ED admission was an independent predictor of in-hospital mortality, with an Odd Ratio (OR) of 2.28 (95% confidence interval, 1.16–4.48). In addition, the SIC score was an independent predictor for the development of overt-DIC (OR 10.39, (95% CI, 4.08–26.46)), new organ injury (OR 6.33, (95% CI, 2.90–13.83)), bleeding (OR 4.83, (95% CI, 2.22–10.50)) and thrombotic events (OR 9.48, (95% CI, 2.95–30.40)), as well as the need for blood component transfusion (OR 5.28, (95% CI, 2.35–11.83)). In ED patients with sepsis, the SIC score is an early predictor of in-hospital mortality and the development of severe coagulopathy-related complications.


Keywords

Sepsis; Septic coagulopathy; Disseminated intravascular coagulation; SIC score; Emergency department


Cite and Share

Gianluca Tullo,Marcello Covino,Luigi Carbone,Flavio Lo Dico,Giulia Corsini,Andrea Piccioni,Davide Della Polla,Martina Petrucci,Claudio Sandroni,Benedetta Simeoni,Antonio Gasbarrini,Francesco Franceschi. Sepsis-induced coagulopathy (SIC) score is an independent predictor of mortality and overt-disseminated intravascular coagulation in emergency department patients with sepsis. SignaVitae. 2024. 20(6);33-43.

References

[1] Lupu F, Keshari RS, Lambris JD, Mark Coggeshall K. Crosstalk between the coagulation and complement systems in sepsis. Thrombosis Research. 2014; 133: S28–S31.

[2] Jackson SP, Darbousset R, Schoenwaelder SM. Thromboinflammation: challenges of therapeutically targeting coagulation and other host defense mechanisms. Blood. 2019; 133: 906–918.

[3] Levi M, Schultz M, Van Der Poll T. Sepsis and thrombosis. Seminars in Thrombosis and Hemostasis. 2013; 39: 559–566.

[4] Levi M. Infection and inflammation and the coagulation system. Cardiovascular Research. 2003; 60: 26–39.

[5] Semeraro N, Ammollo CT, Semeraro F, Colucci M. Sepsis, thrombosis and organ dysfunction. Thrombosis Research. 2012; 129: 290–295.

[6] Iba T, Umemura Y, Watanabe E, Wada T, Hayashida K, Kushimoto S. Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy. Acute Medicine & Surgery. 2019; 6: 223–232.

[7] Hayakawa M, Saito S, Uchino S, Yamakawa K, Kudo D, Iizuka Y, et al. Characteristics, treatments, and outcomes of severe sepsis of 3195 ICU-treated adult patients throughout Japan during 2011–2013. Journal of Intensive Care. 2016; 4: 44.

[8] Yamakawa K, Yoshimura J, Ito T, Hayakawa M, Hamasaki T, Fujimi S. External validation of the two newly proposed criteria for assessing coagulopathy in sepsis. Thrombosis and Haemostasis. 2019; 119: 203–212.

[9] Iba T, Levi M, Thachil J, Helms J, Scarlatescu E, Levy JH. Communication from the scientific and standardization committee of the international society on thrombosis and haemostasis on sepsis-induced coagulopathy in the management of sepsis. Journal of Thrombosis and Haemostasis. 2023; 21: 145–153.

[10] Iba T, Arakawa M, Di Nisio M, Gando S, Anan H, Sato K, et al. Newly proposed sepsis-induced coagulopathy precedes international society on thrombosis and haemostasis overt-disseminated intravascular coagulation and predicts high mortality. Journal of Intensive Care Medicine. 2020; 35: 643–649.

[11] Iba T, Umemura Y, Wada H, Levy JH. Roles of coagulation abnormalities and microthrombosis in sepsis: pathophysiology, diagnosis, and treatment. Archives of Medical Research. 2021; 52: 788–797.

[12] Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016; 315: 801.

[13] Iba T, Nisio MD, Levy JH, Kitamura N, Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ Open. 2017; 7: e017046.

[14] Taylor F, Toh C, Hoots K, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thrombosis and Haemostasis. 2001; 86: 1327–1330.

[15] Wendon J, Cordoba J, Dhawan A, Larsen FS, Manns M, Nevens F, et al. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. Journal of Hepatology. 2017; 66: 1047–1081.

[16] ARDS Definition Task Force; Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012; 307: 2526–2533.

[17] Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice. 2012; 120: c179–c184.

[18] Chaudhry N, Duggal AK. Sepsis associated encephalopathy. Advances in Medicine. 2014; 2014: 1–16.

[19] Lee HJ, Ko BS, Ryoo SM, Han E, Suh GJ, Choi SH, et al. Modified cardiovascular SOFA score in sepsis: development and internal and external validation. BMC Medicine. 2022; 20: 263.

[20] Schmoch T, Möhnle P, Weigand MA, Briege J, Bauer M, Bloos F, et al. The prevalence of sepsis-induced coagulopathy in patients with sepsis - a secondary analysis of two German multicenter randomized controlled trials. Annals of Intensive Care. 2023; 13: 3.

[21] Tanaka C, Tagami T, Kudo S, Takehara A, Fukuda R, Nakayama F, et al. Validation of sepsis-induced coagulopathy score in critically ill patients with septic shock: post hoc analysis of a nationwide multicenter observational study in Japan. International Journal of Hematology. 2021; 114: 164–171.

[22] Ding R, Wang Z, Lin Y, Liu B, Zhang Z, Ma X. Comparison of a new criteria for sepsis-induced coagulopathy and International Society on Thrombosis and Haemostasis disseminated intravascular coagulation score in critically ill patients with sepsis 3.0. Blood Coagulation & Fibrinolysis. 2018; 29: 551–558.

[23] Brink A, Alsma J, Verdonschot RJCG, Rood PPM, Zietse R, Lingsma HF, et al. Predicting mortality in patients with suspected sepsis at the emergency department; a retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score. PLOS ONE. 2019; 14: e0211133.

[24] Oduncu AF, Kıyan GS, Yalçınlı S. Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department. The American Journal of Emergency Medicine. 2021; 48: 54–59.

[25] Mustafić S, Brkić S, Prnjavorac B, Sinanović A, Porobić Jahić H, Salkić S. Diagnostic and prognostic value of procalcitonin in patients with sepsis. Medicinski Glasnik. 2018; 15: 93–100.

[26] Anand D, Das S, Ray S, Bhargava S, Srivastava LM. Interrelationship between procalcitonin and organ failure in sepsis. Indian Journal of Clinical Biochemistry. 2014; 29: 93–96.

[27] Covino M, Gallo A, Montalto M, De Matteis G, Burzo ML, Simeoni B, et al. The role of early procalcitonin determination in the emergency departiment in adults hospitalized with fever. Medicina. 2021; 57: 179.

[28] Jekarl DW, Lee S, Kim M, Kim Y, Woo SH, Lee WJ. Procalcitonin as a prognostic marker for sepsis based on SEPSIS‐3. Journal of Clinical Laboratory Analysis. 2019; 33: e22996.

[29] Asoğlu R, Tibilli H, Afşin A, Türkmen S, Barman HA, Asoğlu E. Procalcitonin is a predictor of disseminated intravascular coagulation in patients with fatal COVID-19. European Review for Medical and Pharmacological Sciences. 2020; 24: 11953–11959.

[30] Al-Samkari H, Karp Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020; 136: 489–500.

[31] Asakura H, Ogawa H. COVID-19-associated coagulopathy and disseminated intravascular coagulation. International Journal of Hematology. 2021; 113: 45–57.

[32] Kovačević M, Rizvanović N, Šabanović Adilović A, Čaušević S. COVID-19 associated coagulopathy in septic critically ill patients—a retrospective cohort study. Medicinski Glasnik. 2023; 20: 142–147.

[33] De Vita A, De Matteis G, d’Aiello A, Ravenna SE, Liuzzo G, Lanza GA, et al. Incidence and predictors of thrombotic complications in 4742 patients with COVID-19 or other acute infectious respiratory diseases: a propensity score-matched study. Journal of Clinical Medicine. 2021; 10: 4973.

[34] Levi M, Iba T. COVID-19 coagulopathy: is it disseminated intravascular coagulation? Internal and Emergency Medicine. 2021; 16: 309–312.

[35] Wool G, Miller J. The impact of COVID-19 disease on platelets and coagulation. Pathobiology. 2021; 88: 15–27.

[36] Shafiee M, Hosseini S, Behnam- Roudsari S, Alavinia G, Emami A, Toghyani A, et al. Diagnostic and prognostic value of sepsis-induced coagulopathy and international society on thrombosis and hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy. Journal of Research in Medical Sciences. 2021; 26: 102.

[37] Umemura Y, Nishida T, Yamakawa K, Ogura H, Oda J, Fujimi S. Anticoagulant therapies against sepsis‐induced disseminated intravascular coagulation. Acute Medicine & Surgery. 2023; 10: e884.

[38] Iba T, Levi M, Levy JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation. Seminars in Thrombosis and Hemostasis. 2020; 46: 089–095.

[39] Yamakawa K, Umemura Y, Hayakawa M, Kudo D, Sanui M, Takahashi H, et al. Benefit profile of anticoagulant therapy in sepsis: a nationwide multicentre registry in Japan. Critical Care. 2016; 20: 229.

[40] Zhang Z, Yan T, Ren D, Zhou J, Liu L, Li J, et al. Low-molecular-weight heparin therapy reduces 28-day mortality in patients with sepsis-3 by improving inflammation and coagulopathy. Frontiers in Medicine. 2023; 10: 1157775.

[41] Kienast J, Juers M, Wiedermann CJ, Hoffmann JN, Ostermann H, Strauss R, et al. Treatment effects of high‐dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation. Journal of Thrombosis and Haemostasis. 2006; 4: 90–97.

[42] Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Antithrombin and mortality in severe pneumonia patients with sepsis‐associated disseminated intravascular coagulation: an observational nationwide study. Journal of Thrombosis and Haemostasis. 2014; 12: 1470–1479.

[43] Wiedermann CJ. Antithrombin concentrate use in disseminated intravascular coagulation of sepsis: meta‐analyses revisited. Journal of Thrombosis and Haemostasis. 2018; 16: 455–457.

[44] Vincent J, Francois B, Zabolotskikh I, Daga MK, Lascarrou J, Kirov MY, et al. Effect of a recombinant human soluble thrombomodulin on mortality in patients with sepsis-associated coagulopathy. JAMA. 2019; 321: 1993.

[45] Imaura M, Katagiri F, Nagase S, Hatoyama-Tanaka S, Takahashi H, Takayanagi R, et al. Optimal plasma concentration of thrombomodulin alfa to treat sepsis-induced disseminated intravascular coagulation. Shock. 2023; 60: 221–226.

[46] Umemura Y, Yamakawa K. Optimal patient selection for anticoagulant therapy in sepsis: an evidence‐based proposal from Japan. Journal of Thrombosis and Haemostasis. 2018; 16: 462–464.

[47] Yu S, Ma X, Li X. Phenotype-oriented anticoagulant therapy for sepsis: still a work in progress. International Journal of Hematology. 2022; 116: 48–54.

[48] Umemura Y, Yamakawa K, Ogura H, Yuhara H, Fujimi S. Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: a meta-analysis of randomized controlled trials. Journal of Thrombosis and Haemostasis. 2016; 14: 518–530.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top