Coagulation factor levels as prognostic biomarkers: differential profiles in pulmonary versus extrapulmonary sepsis-induced ARDS

Objective To compare the coagulation factor levels in acute respiratory distress syndrome caused by pulmonary infection (ARDSp) and ARDS caused by extrapulmonary sepsis (ARDSexp) patients.Methods This study included 112 ARDSp and 88 ARDSexp patients. Coagulation factor levels were compared within 24 hours after the diagnosis of ARDS.Results In the ARDSexp group, prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly prolonged, fibrinogen (FIB) levels were significantly decreased, and D-dimer (D-D) levels were significantly increased. Coagulation factors V and VII levels were significantly lower, while factor VIII levels and the degree of thrombocytopenia were substantially higher in the ARDSexp group, in contrast to the ARDSp group. In terms of prognosis, the ARDSexp group had longer mechanical ventilation duration and ICU stay duration, and higher 28-d and 90-d mortality (all p < 0.05). D-D > 7 mg/L, coagulation factor V < 70%, elevated sequential organ failure assessment (SOFA) score, and antithrombin III <60% were independent predictors of 28-d mortality.Conclusion This study demonstrates that there are visible coagulation phenotypic distinctions between ARDSp patients and ARDSexp patients. Coagulation factor levels can serve as biomarkers for prognostic assessment and provide a theoretical basis for the development of individualized anticoagulation strategies in clinical practice.