Effects of coagulopathy and its correction on time to source control and clinical outcomes in patients with sepsis

Radiological intervention is often required for infection source control in sepsis, and correcting coagulopathy prior to procedures with bleeding risk is recommended. This study aimed to evaluate the impacts of correcting coagulopathy on time to intervention and on 28-day mortality in patients with sepsis undergoing abdominal radiological interventions.

This retrospective cohort study utilized prospectively collected sepsis registry from the emergency department of a tertiary hospital. Adult patients with sepsis or septic shock who underwent abdominal radiological intervention between January 2011 and December 2020 were included. Coagulopathy was defined as PT-INR > 1.5 or platelet count <50,000/μL. The primary outcome was 28-day mortality, and secondary outcome included major bleeding complications, requiring transfusion, embolization or surgery. Multivariable logistic regression was performed to identify independent associations.

Among the 597 patients analyzed, 161 (27.0 %) had coagulopathy. Among these, 55 (34.2 %) underwent correction prior to intervention. Patients who underwent correction had a significantly longer median time to intervention (15.3 vs. 6.0 h, P < 0.001) and higher 28-day mortality (41.8 % vs. 22.6 %, P = 0.02), but no reduction in major bleeding complications was achieved. In multivariable analysis, coagulopathy correction associated independently with a higher 28-day mortality rate (OR, 2.52; 95 % CI, 1.13-5.66, P = 0.03) but not with the incidence of major bleeding complications (OR 1.80; 95 % CI, 0.83-3.90, P = 0.13).

In septic patients with coagulopathy undergoing abdominal radiological intervention, coagulopathy correction correlated with delayed source control and increased 28-day mortality, without reducing major bleeding complications.