Sepsis induced coagulopathy (SIC): is it monolithic?

Sepsis-induced coagulopathy (SIC) is known to be linked with an increased mortality of sepsis. We designed this study to investigate whether there is heterogeneity in the clinical manifestations of SIC between cases with international normalized ratio (INR) as the dominant factor and those with platelet (PLT) as the dominant factor. In this survey, 1421 SIC patients admitted to Peking Union Medical College Hospital were enrolled. External verification was conducted using data from 4732 SIC patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. According to the difference of INR and PLT, SIC was divided into four subtypes: SIC-severe (PLT < 100 and INR > 1.4), SIC-INR (PLT ≥ 100 and INR > 1.4), SIC-PLT (PLT < 100 and INR ≤ 1.4), and SIC-mild (100 ≤ PLT < 150 and 1.2 < INR ≤ 1.4). The incidence of SIC in sepsis patients was 48.70% (1421/2918). Compared with the SIC-INR group, the SIC-PLT group had shorter activated partial thromboplastin time, lower fibrinogen levels, lower lactate levels, and lower blood glucose levels (P < 0.05). Regarding liver function, compared to the SIC-INR group, the SIC-PLT group exhibited lower levels of total bilirubin, direct bilirubin, and alanine aminotransferase (P < 0.05). Concerning kidney function, the proportion of patients receiving continuous renal replacement therapy support in the SIC-PLT group was lower than that in the SIC-INR group (P < 0.05). There was no statistically significant difference in SOFA total score between the SIC-INR group and the SIC-PLT group after deducting the coagulation system score. In terms of outcomes, there were no statistically differences in costs and mortality between the SIC-INR and the SIC-PLT group, but the SIC-PLT group had shorter duration of mechanical ventilation and hospital stays after diagnosis of sepsis than the SIC-INR group (P < 0.05). Data from the MIMIC-IV database further corroborate there was heterogeneity between the SIC-INR group and the SIC-PLT group. The incidence rate of DVT in the SIC-PLT group was significantly lower than that in the SIC-INR group (P < 0.05). SIC with PLT change as the dominant factor and SIC with INR change as the dominant factor exhibited significant heterogeneity. Sepsis-induced coagulopathy (SIC), a condition that can lead to DIC, is associated with a significantly higher mortality rate. The diagnosis of SIC relies on the international normalized ratio (INR), which is a measure of blood clotting time, and platelet count (PLT), in conjunction with the sequential organ failure assessment (SOFA). Compared with SIC cases where INR changes are the dominant factor, those with PLT changes as the dominant factor exhibit milder liver and kidney impairment and require shorter durations of mechanical ventilation time and hospital stay after diagnosis. When studying SIC, it is important to note the heterogeneity of the aforementioned phenotypes.