Sepsis-Induced Coagulopathy and Hypoalbuminemia: Endothelial Damage as Common Pathway and Clinical Implications on Mortality and Transfusion Risk

<b>Background:</b> Sepsis-induced coagulopathy (SIC) and hypoalbuminemia represent distinct yet interrelated manifestations of endothelial dysfunction in sepsis. While both have been individually associated with increased mortality, their combined prognostic value remains unexplored. This study aimed to assess the relationship between the SIC score and serum albumin levels and to evaluate their integrated role in predicting mortality and bleeding risks in septic patients. <b>Methods:</b> We conducted a prospective observational study enrolling adult patients with community-acquired sepsis admitted to an Intermediate Medical Care Unit between January 2023 and June 2024. The primary outcome was 30-day all-cause mortality. The secondary outcome was the occurrence of ISTH-defined major bleeding. Multivariable logistic regression and Net Reclassification Improvement (NRI) analyses were performed to evaluate the predictive value of albumin when added to the SIC score. <b>Results:</b> A total of 413 patients were enrolled; 18.4% had a positive SIC score. The serum albumin and SIC score were inversely correlated (r = -0.189, <i>p</i> < 0.001). Both variables were independently associated with 30-day mortality and major bleeding. The addition of albumin significantly improved the predictive performance of the SIC score (NRI = 0.276 for mortality; NRI = 0.268 for bleeding; both <i>p</i> = 0.003). The cluster analysis identified distinct phenotypes based on albumin and SIC profiles, with differing clinical trajectories and transfusion needs. <b>Conclusions:</b> The combined assessment of the SIC score and serum albumin enhances early risk stratification in sepsis. This dual-parameter approach may support more accurate prognostication and individualized management in septic patients.