Coagulopathy Parameters Predictive of Outcomes in Sepsis-induced Acute Respiratory Distress Syndrome: A Sub-Analysis of the Two Prospective Multicenter Cohort Studies.
Journal
Shock (Augusta, Ga.)
ISSN: 1540-0514
Titre abrégé: Shock
Pays: United States
ID NLM: 9421564
Informations de publication
Date de publication:
16 Nov 2023
16 Nov 2023
Historique:
medline:
27
11
2023
pubmed:
27
11
2023
entrez:
27
11
2023
Statut:
aheadofprint
Résumé
Although coagulopathy is often observed in acute respiratory distress syndrome (ARDS), its clinical impact remains poorly understood. This study aimed to clarify the coagulopathy parameters that are clinically applicable for prognostication and to determine anticoagulant indications in sepsis-induced ARDS. This study enrolled patients with sepsis-derived ARDS from two nationwide multicenter, prospective observational studies. We explored coagulopathy parameters that could predict outcomes in the FORECAST cohort, and the defined coagulopathy criteria were validated in the SPICE-ICU cohort. The correlation between anticoagulant use and outcomes was also evaluated. A total of 181 patients with sepsis-derived ARDS in the FORECAST study and 61 patients in the SPICE-ICU study were included. In a preliminary study, we found the set of PT-INR ≥1.4 and platelets ≤12 × 104/μL, Thrombocytopenia and Elongated Prothrombin time, TEP, coagulopathy as the best coagulopathy parameters, and used for further analysis, of which odds ratio of TEP coagulopathy for in-hospital mortality adjusted for confounding was 3.84 (95% CI, 1.66-8.87; p = 0.005). In the validation cohort, the adjusted odds ratio for in-hospital mortality was 32.99 (95% CI, 2.60-418.72; p = 0.002). Although patients without TEP coagulopathy showed significant improvements in oxygenation over the first 4 days, patients with TEP coagulopathy showed no significant improvement (ΔPaO2/FiO2 ratio, 24 ± 20 vs. 90 ± 9; p = 0.026). Furthermore, anticoagulant use was significantly correlated with mortality and oxygenation recovery in patients with TEP coagulopathy but not in patients without TEP coagulopathy. TEP coagulopathy is closely associated with better outcomes and responses to anticoagulant therapy in sepsis-induced ARDS, and our coagulopathy criteria may be clinically useful.Trial registrationFORECAST study: UMIN-CTR ID: UMIN000019742. Registration date: November 11th, 2015.SPICE-ICU study: UMIN-CTR ID: UMIN000027258. Registration date: May 6th, 2017.
Sections du résumé
BACKGROUND
BACKGROUND
Although coagulopathy is often observed in acute respiratory distress syndrome (ARDS), its clinical impact remains poorly understood.
OBJECTIVES
OBJECTIVE
This study aimed to clarify the coagulopathy parameters that are clinically applicable for prognostication and to determine anticoagulant indications in sepsis-induced ARDS.
METHOD
METHODS
This study enrolled patients with sepsis-derived ARDS from two nationwide multicenter, prospective observational studies. We explored coagulopathy parameters that could predict outcomes in the FORECAST cohort, and the defined coagulopathy criteria were validated in the SPICE-ICU cohort. The correlation between anticoagulant use and outcomes was also evaluated.
RESULTS
RESULTS
A total of 181 patients with sepsis-derived ARDS in the FORECAST study and 61 patients in the SPICE-ICU study were included. In a preliminary study, we found the set of PT-INR ≥1.4 and platelets ≤12 × 104/μL, Thrombocytopenia and Elongated Prothrombin time, TEP, coagulopathy as the best coagulopathy parameters, and used for further analysis, of which odds ratio of TEP coagulopathy for in-hospital mortality adjusted for confounding was 3.84 (95% CI, 1.66-8.87; p = 0.005). In the validation cohort, the adjusted odds ratio for in-hospital mortality was 32.99 (95% CI, 2.60-418.72; p = 0.002). Although patients without TEP coagulopathy showed significant improvements in oxygenation over the first 4 days, patients with TEP coagulopathy showed no significant improvement (ΔPaO2/FiO2 ratio, 24 ± 20 vs. 90 ± 9; p = 0.026). Furthermore, anticoagulant use was significantly correlated with mortality and oxygenation recovery in patients with TEP coagulopathy but not in patients without TEP coagulopathy.
CONCLUSION
CONCLUSIONS
TEP coagulopathy is closely associated with better outcomes and responses to anticoagulant therapy in sepsis-induced ARDS, and our coagulopathy criteria may be clinically useful.Trial registrationFORECAST study: UMIN-CTR ID: UMIN000019742. Registration date: November 11th, 2015.SPICE-ICU study: UMIN-CTR ID: UMIN000027258. Registration date: May 6th, 2017.
Identifiants
pubmed: 38010069
doi: 10.1097/SHK.0000000000002269
pii: 00024382-990000000-00326
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 by the Shock Society.