A Simple Platelet-Centered Coagulation-Inflammation Combined Score for Predicting In-Hospital Mortality in Sepsis

Accurate mortality prediction in sepsis requires assessing coagulation and inflammatory disturbances, yet existing scores are complex or incompletely capture these interconnected processes. We developed and internally validated a simple score combining inflammatory and platelet-related indicators with clinical parameters to predict in-hospital mortality in sepsis.

This retrospective study included 6175 adults with sepsis from the MIMIC-IV database. Patients were randomly divided into training (n=4322) and validation (n=1853) cohorts. Candidate predictors were screened by least absolute shrinkage and selection operator regression, and final variables entered multivariable logistic regression to construct the Coagulation-Inflammation Combined Score (CICS). Performance was assessed by discrimination, calibration, internal bootstrap validation, and decision curve analysis.

Of 6175 patients, 807 (13.1%) died during hospitalization. The final CICS incorporated five routinely available variables: lactate, Glasgow Coma Scale score, age, neutrophil-to-lymphocyte ratio, and platelet count. Discrimination was good, with area under the receiver operating characteristic curve 0.768 (95% CI, 0.747-0.788) in training and 0.806 (95% CI, 0.776-0.835) in validation cohorts, comparable to SOFA (DeLong P=0.526 and P=0.180). Calibration was acceptable (Brier scores 0.102 and 0.091). Bootstrap validation indicated minimal optimism, and decision curve analysis showed exploratory findings across clinically relevant thresholds.

The CICS is a parsimonious prognostic score using five routinely available variables from the first 24 hours after ICU admission. It showed discrimination comparable to SOFA, acceptable calibration, and favorable decision-curve performance. CICS should be interpreted as a separate prognostic score for early ICU stratification once first-24-hour data are available, rather than for emergency department triage or ICU admission decisions.