Biomarkers and clinical factors associated with sepsis-induced coagulopathy: A systematic review and meta-analysis

ObjectiveSepsis-induced coagulopathy (SIC) is a life-threatening complication that significantly impacts patient prognosis. This systematic review and meta-analysis aimed to evaluate clinical and biological indicators associated with the development of SIC to facilitate early risk identification.MethodsWe searched nine databases for studies reporting predictive factors for SIC. Data were pooled using random-effects or fixed-effects models as appropriate. Methodological quality was assessed using the Newcastle-Ottawa Scale.ResultsA total of 34 studies involving 37,459 patients were included. Meta-analysis revealed that several markers showed a significant association with SIC. Glycocalyx degradation emerged as a strong predictor (OR = 11.85, 95% CI: 8.59-16.34). Other associated markers included reduced Fibrinogen (OR = 4.35, 95% CI: 2.47-7.69), Albumin (OR = 2.5, 95% CI: 1.82-3.45), Neutrophil Extracellular Traps (OR = 2.4, 95% CI: 1.81-3.19), increased circulating Microparticles (OR = 1.61, 95% CI: 1.33-1.95), elevated Lactate(OR = 1.18, 95% CI: 1.13-1.23) and Thrombomodulin (OR = 1.10, 95% CI: 0.97-1.26), Procalcitonin, APACHE II score and C-reactive protein were also demonstrated predictive value for SIC occurrence.ConclusionOur findings identify multiple biological and clinical predictors associated with SIC. However, these results should be interpreted as statistical associations rather than direct causal links. These markers may assist clinicians in early recognition of high-risk patients, though further prospective trials are needed to confirm their clinical utility.RegistrationThis study was registered on the PROSPERO (CRD420250653820).