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Prognostic value of sepsis-induced coagulation abnormalities: an early assessment in the emergency department

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Abstract

To evaluate if the assessment of coagulation abnormalities at ED admission could improve prognostic assessment of septic patients. This report utilizes a portion of the data collected in a prospective study, with the aim to identify reliable biomarkers for an early sepsis diagnosis. In the period November 2011–December 2016, we enrolled 268 patients, admitted to our High-Dependency Unit with a diagnosis severe sepsis/septic shock. Study-related blood samplings were performed at ED-HDU admission (T0), after 6 h (T6) and 24 h (T24): D-dimer, thrombin–antithrombin complex (TAT) and prothrombin fragment F1 + 2 levels were analyzed. The primary end-points were day-7 and in-hospital mortality. Day-7 mortality rate was 16%. D-dimer (T0: 4661 ± 4562 µg/ml vs 3190 ± 7188 µg/ml; T6: 4498 ± 4931 µg/ml vs 2822 ± 5623 µg/ml; T24 2905 ± 2823 µg/ml vs 2465 ± 4988 µg/ml, all p < 0.05) and TAT levels (T0 29 ± 45 vs 22 ± 83; T6 21 ± 22 vs 15 ± 35; T24 16 ± 19 vs 13 ± 30, all p < 0.05) were higher among non-survivors compared to survivors. We defined an abnormal coagulation activation (COAG+) as D-dimer > 500 µg/ml and TAT > 8 ng/ml (for both, twice the upper normal value). Compared to COAG−, COAG+ patients showed higher lactate levels at the earliest evaluations (T0: 3.3 ± 2.7 vs 2.5 ± 2.3, p = 0.041; T6: 2.8 ± 3.4 vs 1.8 ± 1.6, p = 0.015); SOFA score was higher after 24 h (T24: 6.7 ± 3.1 vs 5.4 ± 2.9, p = 0.008). At T0, COAG+ patients showed a higher day-7 mortality rate (HR 2.64; 95% CI 1.14–6.11, p = 0.023), after adjustment for SOFA score and lactate level. Presence of abnormal coagulation at ED admission shows an independent association with an increased short-term mortality rate.

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Authors and Affiliations

  1. High-Dependency Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Careggi, Lg. Brambilla 3, 50134, Florence, Italy

    Francesca Innocenti, Camilla Tozzi, Chiara Donnini, Federico Meo, Irene Giacomelli, Maria Luisa Ralli, Michela Zari, Francesca Caldi, Irene Tassinari, Maurizio Zanobetti & Riccardo Pini

  2. Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy

    Anna Maria Gori, Betti Giusti, Alice Sereni, Elena Sticchi & Rossella Marcucci

Authors
  1. Francesca Innocenti
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  2. Anna Maria Gori
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  3. Betti Giusti
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  4. Camilla Tozzi
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  5. Chiara Donnini
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  6. Federico Meo
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  7. Irene Giacomelli
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  8. Maria Luisa Ralli
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  9. Alice Sereni
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  10. Elena Sticchi
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  11. Michela Zari
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  12. Francesca Caldi
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  13. Irene Tassinari
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  14. Maurizio Zanobetti
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  15. Rossella Marcucci
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  16. Riccardo Pini
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Correspondence to Francesca Innocenti.

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Statement of human and animal rights

The study was conducted in compliance with the Declaration of Helsinki at the Careggi University Hospital.

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The study protocol was approved by the local Ethics Committee, and all subjects provided oral.

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Innocenti, F., Gori, A.M., Giusti, B. et al. Prognostic value of sepsis-induced coagulation abnormalities: an early assessment in the emergency department. Intern Emerg Med 14, 459–466 (2019). https://doi.org/10.1007/s11739-018-1990-z

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  • DOI: https://doi.org/10.1007/s11739-018-1990-z

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