Relationship between trajectory of coagulation index, duration of coagulation disorder, and prognosis in patients with sepsis in ICU

Abstract

Background Platelet count (PLT), activated partial thromboplastin time (APTT), and prothrombin time-international normalized ratio (PT-INR) are routinely monitored during ICU hospitalization. Nonetheless, the impact of the longitudinal PLT, APTT, and PT-INR trajectories in patients with sepsis remains unclear. Furthermore, the association between duration of coagulation disorders and prognosis in sepsis is unclear. Methods Based on the MIMIC-IV database, we applied group-based trajectory modeling (GBTM) to identify PLT, APTT, and PT-INR trajectories among ICU patients with sepsis and explored the relationship between these trajectories and 28-day mortality rates. Secondly, we determined the presence of SIC based on daily PLT, PT-INR, and Sequential Organ Failure Assessment (SOFA) scores in patients. And, by using COX proportional hazard model we assessed the association between the duration of coagulation disorders and prognosis. Results 2159 sepsis patients were included and divided into six PLT, APTT, and PT-INR trajectory groups. We found that patients with persistent thrombocytopenia, prolonged APTT, and elevated PT-INR had the highest risk of death and were independently associated with a poor prognosis (HR 4.60 [95% CI:2.98–7.10]). Moreover, persistent SIC within five days of ICU admission was an independent predictor of 28-day mortality compared to patients without SIC (HR:1.79[95% CI:1.33–2.40]). Conclusion PLT, APTT, and PT-INR trajectories have the potential to distinguish sepsis subphenotypes with varying mortality risks. Using GBTM, we can better comprehend the heterogeneity of coagulation function.