von Willebrand factor and fibrin monomer - induced septic shock coagulation typing: Clinical comparison between thrombotic thrombocytopenic purpura - like syndrome and sepsis - induced coagulopathy with prognostic implications.

OBJECTIVES

This study aims to investigate the pathological mechanisms, clinical features, and prognostic differences between thrombotic thrombocytopenic purpura-like syndrome (TTP-like syndrome) and sepsis-induced coagulopathy (SIC) in patients experiencing septic shock. The findings will provide a basis for subtype-guided diagnosis and treatment of coagulation disorders.

METHODS

In this single-center retrospective cohort, 250 septic shock patients were divided into TTP-like syndrome (n = 101), SIC (n = 113), and control (n = 36) groups. Platelet count, vWF, FM, Sequential Organ Failure Assessment (SOFA) scores, and 28-day mortality were analyzed to compare coagulation phenotypes and outcomes.

RESULTS

The TTP-like syndrome group was characterized by thrombocytopenia, with a median platelet (PLT) decline rate of 49.10 %. This group also exhibited markedly elevated vWF antigen levels, averaging 334.66 ± 80.04 %. Additionally, all patients in this group presented with multiple organ dysfunction syndrome (MODS) at a rate of 100 %. In contrast, the SIC group demonstrated more severe platelet consumption, with a median PLT of 42 × 109/L, elevated fibrinogen degradation product (FM) levels (median 9.22 μg/mL), and a significantly higher 28-day mortality rate (35.40 % vs. 11.88 % in the TTP-like group). The patterns of organ injury varied between the two groups; the SIC group displayed more pronounced liver (SOFA 1.43 ± 1.08) and renal (SOFA 1.41 ± 1.47) involvement, while the TTP-like syndrome group predominantly exhibited circulatory (SOFA 2.46 ± 1.45) and respiratory (SOFA 2.53 ± 0.76) dysfunction. vWF and FM had some predictive value for 28-day mortality, with area under the curve values of 0.59 and 0.60, respectively.

CONCLUSION

TTP-like syndrome and SIC represent heterogeneous coagulation phenotypes in septic shock, with differences in biomarkers, organ injury, and prognosis. A vWF- and FM-guided subtype classification may improve individualized treatment strategies and prognostic management.