Association between nutritional status and sepsis-induced coagulopathy: a multicenter retrospective cohort study

Malnutrition and sepsis-induced coagulopathy (SIC) are common and critical complications in septic patients. This study aimed to evaluate the association between nutritional status and SIC, as well as their combined effects on clinical outcomes in adult septic patients.

This retrospective study extracted data from the MIMIC-IV v3.1 and eICU databases, and additionally enrolled adult patients with sepsis who received treatment at Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from 2021 to October 2022. Baseline clinical characteristics were compared between patients with and without SIC, and between patients with and without nutritional risk. Logistic regression models were constructed to identify independent risk factors for SIC, and restricted cubic spline curves were plotted to visualize dose-response relationships. The Random Forest machine learning method was used to evaluate the association between nutritional indicators and SIC. We used Spearman correlation analysis to investigate the relationship between nutritional indicators and SOFA and SIC scores, as well as coagulation indicators. The associations among nutritional indicators were assessed using logistic proportional hazards models, and interactions were examined on both additive and multiplicative scales.

Patients with SIC had lower Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) scores and higher mortality rates, with statistically significant differences observed in the MIMIC and eICU cohorts (p < 0.001). Concurrent low GNRI and PNI levels correlated with higher SIC risk. In the eICU cohort, univariate and multivariate regression analyses confirmed that dual low nutritional indices independently increased SIC risk (OR = 2.24, 95% CI: 1.76-2.86, p < 0.001; adjusted OR = 2.18, 95% CI: 1.67-2.85, p < 0.001). Restricted cubic splines suggested that patients with higher GNRI and PNI scores have a lower probability of SIC occurrence. The MIMIC database also showed similar results. Spearman analysis revealed positive correlations among the nutritional indicators, as well as negative correlations with the SOFA and SIC scores. No significant multiplicative or additive interactions were identified between GNRI and PNI.

Malnutrition and SIC are associated with higher mortality rates in sepsis. Nutritional status is independently associated with the risk of SIC in adults.