Routine coagulation tests on ICU admission are associated with mortality in sepsis: an observational study

Area of Science:

• Critical Care Medicine
• Hematology
• Sepsis Research

Background:

• Low platelet count is a known mortality predictor in intensive care units (ICUs), included in scoring systems like SAPS 3.
• The prognostic value of routine coagulation tests, such as APTT and PT-INR, in severe sepsis or septic shock remains unclear.

Purpose of the Study:

• To investigate if activated partial thromboplastin time (APTT) and prothrombin time-international normalized ratio (PT-INR) on ICU admission are associated with mortality in severe sepsis or septic shock patients.
• To determine if these associations are independent of the Simplified Acute Physiologic Score 3 (SAPS 3).

Main Methods:

• Retrospective, single-center study of 647 patients with severe sepsis or septic shock admitted to the ICU between 2007 and 2014.
• APTT and PT-INR results within 1.5 hours of admission were analyzed using Cox regression, with SAPS 3 as an independent variable.

Main Results:

• Both APTT and PT-INR showed a significant correlation with mortality.
• Hazard ratios (HR) were 1.014 for APTT and 1.422 for PT-INR, indicating increased mortality risk.
• SAPS 3 also predicted mortality with an HR of 1.036.

Conclusions:

• Prolonged APTT and elevated PT-INR on ICU admission are independently associated with increased mortality in severe sepsis/septic shock.
• These coagulation parameters reflect significant morbidity not captured by the SAPS 3 score.
• APTT and PT-INR can enhance risk stratification for critically ill septic patients.