COAGULOPATHY PARAMETERS PREDICTIVE OF OUTCOMES IN SEPSIS-INDUCED ACUTE RESPIRATORY DISTRESS SYNDROME: A SUBANALYSIS OF THE TWO PROSPECTIVE MULTICENTER COHORT STUDIES

Author:

Matsuoka Tadashi1,Fujishima Seitaro2,Sasaki Junchi1,Gando Satoshi,Saitoh Daizoh3,Kushimoto Shigeki4,Ogura Hiroshi5,Abe Toshikazu,Shiraishi Atsushi6,Mayumi Toshihiko7,Kotani Joji8,Takeyama Naoshi9,Tsuruta Ryosuke10,Takuma Kiyotsugu11,Yamashita Norio12,Shiraishi Shin-ichiro13,Ikeda Hiroto14,Shiino Yasukazu15,Tarui Takehiko16,Nakada Taka-aki17,Hifumi Toru18,Otomo Yasuhiro19,Okamoto Kohji20,Sakamoto Yuichiro21,Hagiwara Akiyoshi22,Masuno Tomohiko23,Ueyama Masashi24,Fujimi Satoshi25,Yamakawa Kazuma25,Umemura Yutaka5,

Affiliation:

1. Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan

2. Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan

3. Division of Traumatology, Research Institute, National Defense Medical College, Japan

4. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan

5. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan

6. Emergency and Trauma Center, Kameda Medical Center, Japan

7. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan

8. Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan

9. Advanced Critical Care Center, Aichi Medical University Hospital, Japan

10. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Japan

11. Emergency and Critical Care Center, Kawasaki Municipal Hospital, Japan

12. Department of Emergency and Critical Care Medicine, School of Medicine, Kurume University, Japan

13. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Japan

14. Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine

15. Department of Acute Medicine, Kawasaki Medical School, Japan

16. Department of Emergency Medical Care, Kyorin University Faculty Health Sciences, Japan

17. Department of Emergency and Critical Care Medicine Chiba University Graduate School of Medicine, Japan

18. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan

19. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Japan

20. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Japan

21. Emergency and Critical Care Medicine, Saga University Hospital, Japan

22. Center Hospital of the National Center for Global Health and Medicine, Japan

23. Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan

24. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Japan

25. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan

Abstract

ABSTRACT Background: Although coagulopathy is often observed in acute respiratory distress syndrome (ARDS), its clinical impact remains poorly understood. Objectives: This study aimed to clarify the coagulopathy parameters that are clinically applicable for prognostication and to determine anticoagulant indications in sepsis-induced ARDS. Method: This study enrolled patients with sepsis-derived ARDS from two nationwide multicenter, prospective observational studies. We explored coagulopathy parameters that could predict outcomes in the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis, and Trauma (FORECAST) cohort, and the defined coagulopathy criteria were validated in the Sepsis Prognostication in Intensive Care Unit and Emergency Room—Intensive Care Unit (SPICE-ICU) cohort. The correlation between anticoagulant use and outcomes was also evaluated. Results: A total of 181 patients with sepsis-derived ARDS in the FORECAST study and 61 patients in the SPICE-ICU study were included. In a preliminary study, we found the set of prothrombin time–international normalized ratio ≥1.4 and platelet count ≤12 × 104/μL, and thrombocytopenia and elongated prothrombin time (TEP) coagulopathy as the best coagulopathy parameters and used it for further analysis; the odds ratio (OR) of TEP coagulopathy for in-hospital mortality adjusted for confounding was 3.84 (95% confidence interval [CI], 1.66–8.87; P = 0.005). In the validation cohort, the adjusted OR for in-hospital mortality was 32.99 (95% CI, 2.60–418.72; P = 0.002). Although patients without TEP coagulopathy showed significant improvements in oxygenation over the first 4 days, patients with TEP coagulopathy showed no significant improvement (ΔPaO2/FiO2 ratio, 24 ± 20 vs. 90 ± 9; P = 0.026). Furthermore, anticoagulant use was significantly correlated with mortality and oxygenation recovery in patients with TEP coagulopathy but not in patients without TEP coagulopathy. Conclusion: Thrombocytopenia and elongated prothrombin time coagulopathy is closely associated with better outcomes and responses to anticoagulant therapy in sepsis-induced ARDS, and our coagulopathy criteria may be clinically useful.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Emergency Medicine

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