New diagnostic strategy for sepsis-induced disseminated intravascular coagulation: a prospective single-center observational study

Abstract

Introduction: Inflammation and coagulation are closely interrelated pathophysiologic processes in the pathogenesis of sepsis. However, the diagnostic criteria of sepsis and disseminated intravascular coagulation (DIC) are different. This study aimed to define a biomarker panel to predict sepsis-induced DIC in emergency department patients.

Methods: Eighty-two patients who were admitted to the emergency department of a tertiary university hospital were included in this study. The inclusion criteria were as follows: (1) age >18 years; (2) ≥1 systemic inflammatory response syndrome (SIRS) criteria. Patients were excluded if they lacked biomarker data or apparent clinical manifestations. Eleven biomarkers were assayed from blood drawn on ED admission. Receiver operating curve (ROC) analysis including the area under the ROC and multivariable logistic regression were used to identify an optimal combination of biomarkers to create a diagnostic panel. The derived formula for weighting biomarker values was used to determine the severity of sepsis-induced DIC, which was divided into three categories: mild, moderate, and severe. We also investigated the ability of this classification to predict secondary outcome measures of rates of sepsis and DIC, DIC score, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure score (SOFA) score, and 28-day all-cause mortality.

Results: Among the 11 biomarkers tested, the optimal 2-marker panel comprised presepsin and protein C. The area under the curve for the accuracies of predicting sepsis and DIC from these two biomarkers were 0.913 and 0.880, respectively. When patients were divided according to the severity of sepsis-induced DIC, all secondary outcomes except for mortality were significantly higher depending on the severity (P < .0001). The overall mortality rates of mild, moderate, and severe sepsis-induced DIC were 7.14%, 15.4%, and 28.6%, respectively (P = .0994).

Conclusions: A biomarker panel of presepsin and protein C is predictive of the severity of sepsis-induced DIC in suspected ED patients. These criteria for sepsis-induced DIC are very simple, easy to implement, and can be used in intensive care units as a point-of-care test.

Figure 1

Severity and classification of sepsis-induced DIC. A) Severity of sepsis-induced DIC. Patients were classified into the following three groups according to presepsin and PC levels: (1) severe: presepsin >900 pg/mL and PC <45%; (2) mild: presepsin <650 pg/mL and PC >45%, or 650 < presepsin < 900 pg/mL and PC >55%; (3) moderate: parameters between the ranges of severe and mild. B) Classification of sepsis-induced DIC (SEDIC) criteria. The categories described in Figure 1A were classified as follows: (1) severe, SEDIC; (2) moderate, pre-SEDIC; (3) mild, non-SEDIC. DIC, disseminated intravascular coagulation; PC, protein C.