Use of the international normalized ratio for the diagnosis of sepsis in thrombocytopenic blood cancer patients

Objective. To investigate the role of international normalized ratio (INR) as a marker of sepsis-related clotting disorders in blood cancer patients with thrombocytopenia. Material and methods. A retrospective analysis included 279 patients with hematologic malignancies admitted to ICU due to infectious complications or sepsis. Clinical and laboratory data, specifically those required for calculating Sequential Organ Failure Assessment (SOFA) scores, were extracted. Predictive value of individual SOFA parameters for mortality was evaluated. We analyzed predictive role of coagulation parameters in sepsis to find the most suitable alternative to platelet count. Results. Sepsis, as defined by the Sepsis-3 criteria, was diagnosed in 256 (91.7%) out of 279 patients. The overall mortality rate was 34.7%. Thrombocytopenia (platelet count <150·109/L) was present in 236 (84.5%) of patients. In 58 (23.0%) patients, diagnosis of sepsis was due to infectious complication with acute multiple organ dysfunction (SOFA score ≥2) and thrombocytopenia <100·109/l. Comparison of survival in these patients with survival of patients with complex homeostasis disorders according to SOFA scale revealed significant differences (Logrank χ2=12.8; p=0.0003). Platelet count was not a predictor of unfavorable outcome (OR 0.996; 95% CI 0.992—1.0001; p=0.058). Multivariate analysis revealed that the most significant predictor of mortality associated with hemostasis disorders in sepsis in patients with blood diseases was INR (OR 2.14; 95% CI 1.168—3.921; p=0.014). Conclusion. Elevated INR in patients with blood diseases and thrombocytopenia preceding infectious complications and sepsis is associated with higher risk of mortality and may be used as indicator of hemostasis disorders according to SOFA score in diagnosis of sepsis.