Prospective study of early onset coagulopathy as a predictor of outcome in septicaemic patients admitted to a tertiary care centre in eastern India

Abstract

Background: Severe sepsis and septic shock are among the leading causes of morbidity and mortality in intensive care units worldwide despite rapid advances in treatment protocols. Even with all advances, determining the prognosis of sepsis continues to remain tricky. Objectives: This study was planned to assess early onset coagulopathy as a predictor of outcome and mortality in septicemic patients and to study the underlying risk factors associated with mortality in septicemic patients with underlying coagulopathy. Materials and methods: 240 patients fulfilling the criteria of SIRS and sepsis were included in the study. Coagulation parameters including platelet count, prothrombin time – international normalized ratio (PT-INR), activated partial thromboplastin time (aPTT) were evaluated within 48 hours of admission and 28-day mortality was evaluated. Independent predictors of 28-day mortality were evaluated using logistic regression model. Results:Twenty-eight-day mortality rate was 77.77% (98/126) in patients with coagulopathy and a meagre 1.7% (2/114) in patients without coagulopathy which was statistically significant (p<0.05). Log Odd’s ratio calculated using chi-square test was found to be 5.2781, 95% CI (1.633-17.321), which was highly significant. Univariate logistic regression for mortality showed PT-INR, aPTT and APACHE II scores to be independent variables. Multivariate logistic regression revealed severe increase in PT-INR [adjusted OR=1.622 (0.841, 3.092)], moderate increase in aPTT [adjusted OR=4.537 (0.989, 7.326)], and severe increases in aPTT [adjusted OR=3.851 (2.438, 4.996)], and APACHE II scores [adjusted OR=5.381 (1.925, 11.01)], were independently associated with 28-day mortality whereas age, sex, any severity of thrombocytopenia, mild to moderate increase in PT-INR, and mild increase in aPTT were not. Conclusion: Early onset coagulopathy was found to be significantly associated with increased mortality risk in septicemic patients. Septicemic patients should be screened for coagulopathy within 24-48 hours of admission in appropriate clinical scenario to predict mortality outcome and take necessary action at the earliest.