Schmoch Thomas, Möhnle Patrick, Nusshag Christian, Feisst Manuel, Weigand Markus A, Brenner Thorsten
Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Department of Anesthesiology and Intensive Care Medicine, Hôpitaux Robert Schuman - Hôpital Kirchberg, Luxembourg, Luxembourg.
Front Med (Lausanne). 2025 Feb 17;12:1525538. doi: 10.3389/fmed.2025.1525538. eCollection 2025.
Due to the intense crosstalk between the coagulation and immune systems, coagulation disorders are an integral part of the disturbed host response to infection that defines sepsis. These so-called sepsis-induced coagulopathies (SIC) are associated with increased morbidity and mortality. However, we still do not know enough about the prevalence and risk factors for SIC in different patient groups. In this study, we present a secondary analysis of a prospective, observational study. The objectives of this secondary analysis were (1) to estimate the prevalence of SIC at the onset of sepsis, (2) to assess the prevalence of SIC throughout the intensive care unit (ICU) stay using a previously described modified SIC score, and (3) to evaluate the association between SIC and morbidity and mortality. The prevalence of SIC at the onset of sepsis was 15.0% (95% confidence interval [CI]: 9.3-23.3%). A total of 24 additional patients who were SIC-negative at the onset of sepsis developed SIC according to the modified SIC score during their ICU stay. In total, we estimated that 39.0% (95% CI: 30.0-48.8%) of patients experienced relevant SIC during their ICU stay. Septic shock, a high lactate level, and a high Sequential Organ Failure Assessment (SOFA) score at the onset of sepsis in SIC-negative patients were associated with SIC development during the course of the disease. These findings need to be verified in larger cohorts and may represent a starting point for the development of a new screening tool for the identification of patients with sepsis at high risk of developing SIC.
由于凝血系统和免疫系统之间存在强烈的相互作用，凝血功能障碍是脓毒症所定义的宿主对感染的紊乱反应的一个组成部分。这些所谓的脓毒症诱导的凝血病（SIC）与发病率和死亡率的增加相关。然而，我们对不同患者群体中SIC的患病率和危险因素仍了解不足。在本研究中，我们对一项前瞻性观察性研究进行了二次分析。本次二次分析的目的是：（1）估计脓毒症发作时SIC的患病率；（2）使用先前描述的改良SIC评分评估整个重症监护病房（ICU）住院期间SIC的患病率；（3）评估SIC与发病率和死亡率之间的关联。脓毒症发作时SIC的患病率为15.0%（95%置信区间[CI]：9.3 - 23.3%）。共有24名在脓毒症发作时SIC为阴性的患者在ICU住院期间根据改良SIC评分发展为SIC。总体而言，我们估计39.0%（95%CI：30.0 - 48.8%）的患者在ICU住院期间经历了相关的SIC。SIC阴性患者在脓毒症发作时出现感染性休克、高乳酸水平和高序贯器官衰竭评估（SOFA）评分与疾病过程中SIC的发展相关。这些发现需要在更大的队列中得到验证，并且可能代表开发一种用于识别有发生SIC高风险的脓毒症患者的新筛查工具的起点。
