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Sepsis-Associated Coagulopathy Severity Predicts Hospital Mortality*

Lyons, Patrick G. MD1; Micek, Scott T. PharmD2; Hampton, Nicholas PharmD3; Kollef, Marin H. MD1

doi: 10.1097/CCM.0000000000002997
Clinical Investigations

Objectives: To assess whether sepsis-associated coagulopathy predicts hospital mortality.

Design: Retrospective cohort study.

Setting: One-thousand three-hundred beds urban academic medical center.

Patients: Six-thousand one-hundred forty-eight consecutive patients hospitalized between January 1, 2010, and December 31, 2015.

Interventions: Mild sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.2 and less than 1.4 plus platelet count less than or equal to 150,000/µL but greater than 100,000/µL; moderate sepsis-associated coagulopathy was defined with either an international normalized ratio greater than or equal to 1.4 but less than 1.6 or platelets less than or equal to 100,000/µL but greater than 80,000/µL; severe sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.6 and platelets less than or equal to 80,000/µL.

Measurements and Main Results: Hospital mortality increased progressively from 25.4% in patients without sepsis-associated coagulopathy to 56.1% in patients with severe sepsis-associated coagulopathy. Similarly, duration of hospitalization and ICU care increased progressively as sepsis-associated coagulopathy severity increased. Multivariable analyses showed that the presence of sepsis-associated coagulopathy, as well as sepsis-associated coagulopathy severity, was independently associated with hospital mortality regardless of adjustments made for baseline patient characteristics, hospitalization variables, and the sepsis-associated coagulopathy-cancer interaction. Odds ratios ranged from 1.33 to 2.14 for the presence of sepsis-associated coagulopathy and from 1.18 to 1.51 for sepsis-associated coagulopathy severity for predicting hospital mortality (p < 0.001 for all comparisons).

Conclusions: 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.

1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.

2Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO.

3BJC HealthCare, Center for Clinical Excellence, St. Louis, MO.

*See also p. 818.

This work was performed at Barnes-Jewish Hospital, St. Louis, MO.

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Dr. Micek’s institution received funding from Asahi Kasei Pharma America Corp. Dr. Kollef’s effort was supported by the Barnes-Jewish Hospital Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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