From the Journals

Severity of sepsis-associated coagulopathy predicts hospital mortality

Publish date: May 31, 2018

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Simple, straightforward system should inform future studies

This study outlines a simplified classification scheme for coagulopathy with implications that are potentially “profound,” according to authors of an editorial accompanying the journal article.

“Despite the frequency with which hemostatic derangements occur in sepsis, there has not been a widely accepted system for stratification of coagulopathies,” said editorialists Garrett W. Britton, DO, Cody Babcock, PharmD, and Christopher J. Colombo, MD. “Of the most cited criteria, all have varying concordance, and one does not seem to have an advantage over another.”

In the present study, patients with sepsis-associated coagulopathy were stratified into mild, moderate, and severe categories based on international normalized ratio (INR) levels and platelet counts.

While the study has limitations including a sicker patient cohort and arbitrarily chosen severity thresholds, the investigators did find progressively increasing mortality rates that correlated with severity and were independent of confounding variables.

“Overall, this stratification system will prove useful in identifying target populations in future interventional studies,” the editorial authors wrote.

Since sepsis-related mortality remains high, the ultimate goal of research should be identifying varying phenotypes of the disease and targeting them with specific therapies, they added.

“Lyons et al. have aided the first steps in that process with their straightforward classification scheme for sepsis-associated coagulopathy,” they wrote. “Intelligently designed therapeutic trials ‘evaluating’ the response of these phenotypes to new (or old) pharmacotherapy should be the ultimate goal.”

Garrett W. Britton, DO, is with the department of medicine, critical care section, Walter Reed National Military Medical Center, Bethesda, Md. Cody Babcock, PharmD, and Christopher J. Colombo, MD, are with the department of medicine, critical care section, Dwight David Eisenhower Army Medical Center, Fort Gordon, Ga. These comments are derived from their editorial in Critical Care Medicine . The authors had no disclosures beyond reporting government work.


 

FROM CRITICAL CARE MEDICINE


Both presence and severity of sepsis-associated coagulopathy remained independently associated with hospital mortality even after adjustments were made for patient characteristics, hospitalization variables, and interactions between sepsis-associated coagulopathy and cancer, investigators said. Odds ratios ranged from 1.33 to 2.14 for presence of sepsis-associated coagulopathy, and from 1.18 to 1.51 for severity, they reported in the journal.

These data have potential implications for managing patients with sepsis, according to Dr. Lyons and coinvestigators. In particular, severity of sepsis-associated coagulopathy might be used as “another relatively simple way” to compare sepsis patient populations, similar to other markers of severity such as the Sequential Organ Failure Assessment score.

“This could have important implications for comparing the outcomes of patients with sepsis from different hospitals, especially with increasing requirements for public reporting of such data through systems such as the Severe Sepsis/Septic Shock Early Management Bundle-1 and New York State’s Rory’s Regulations,” the investigators wrote.

Reported disclosures for the study included institutional funding from Asahi Kasei Pharma America by one coauthor, and support from Barnes-Jewish Hospital Foundation by another. No other potential conflicts of interest were reported.

SOURCE: Lyons PG et al. Crit Care Med. 2018 May;46(5):736-42.

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