Platelet-To-Lactate Ratio Predicts In-Hospital Mortality in Patients With Sepsis-Induced Coagulopathy: A Retrospective Cohort Study.

AIMS/

BACKGROUND

Sepsis-induced coagulopathy (SIC) is a life-threatening complication with high mortality. The platelet count reflects coagulation status, and the lactate level indicates tissue hypoperfusion, although the prognostic value of these individual parameters is limited. The platelet-to-lactate ratio (PLAC) integrates these parameters, but its prognostic role in SIC is unclear. Here, we investigated the association between the PLAC and in-hospital mortality in patients with SIC.

METHODS

This retrospective cohort study included patients with SIC who were diagnosed after admission to the intensive care unit (ICU) of Chinese PLA General Hospital between December 2017 and October 2025. Multivariate Cox regression was used to assess the association between the PLAC and mortality. Restricted cubic spline (RCS) analysis was used to explore nonlinear relationships and threshold effects. The predictive performance of the PLAC was compared with that of the Sequential Organ Failure Assessment (SOFA) score, the SIC score, and the Charlson comorbidity index score using receiver operating characteristic (ROC) curves and the DeLong test.

RESULTS

Among 1722 patients with SIC, the in-hospital mortality was 26.2% (n = 452). Nonsurvivors had significantly lower PLAC values than did survivors (13.44 vs. 32.75, p < 0.001). Compared with the highest PLAC tertile, the middle and lowest tertiles had significantly higher mortality risk [adjusted hazard ratios (HRs): 1.701 and 3.501, respectively; both p < 0.05]. RCS analysis revealed a threshold effect at PLAC = 28. The area under the curve (AUC) for the PLAC was 0.711 (95% CI: 0.683-0.738), which was comparable to that of the SOFA score (p = 0.135) and superior to that of the SIC score and Charlson comorbidity index score (both p < 0.001). Subgroup analyses revealed a consistent prognostic value across most subgroups, with a significant interaction for coronary artery disease (p < 0.0001 for interaction) and Charlson score (p = 0.042).

CONCLUSION

The PLAC is independently associated with in-hospital mortality in patients with SIC, with a clinically actionable threshold of 28. The PLAC is a simple biomarker that integrates coagulation and perfusion status and is a practical tool for risk stratification. However, multicenter prospective studies are needed to validate these findings.