Infection site modifies the prognostic impact of disseminated intravascular coagulation in sepsis.

BACKGROUND

Disseminated intravascular coagulation (DIC) is a common, life-threatening sepsis complication. Although DIC severity is widely used for risk stratification, whether its prognostic impact varies by infection site remains unclear.

METHODS

We conducted a retrospective cohort study of adults with sepsis admitted to a tertiary critical care center between 2015 and 2025. DIC was defined as a Japanese Association for Acute Medicine score of ≥4 on hospital days 1-3. Patients were grouped by infection site. The primary outcome was in-hospital mortality, and secondary outcomes were ventilator-free days (VFD) and intensive care unit-free days (IFD). Multivariable regression models adjusted for age and sex were used to evaluate the association between DIC and outcomes, including interaction analysis by infection site.

RESULTS

Among 933 patients, 568 (60.9%) developed DIC. DIC was associated with higher mortality and fewer VFD and IFD, with the strongest mortality association in pulmonary (aOR 4.5, 95% confidence interval [CI] 2.2-8.3) and urinary tract infections (aOR 3.2, 95% CI 1.4-9.4) (P for interaction = 0.02). DIC most commonly became apparent on hospital day 2.

CONCLUSIONS

The prognostic impact of DIC in sepsis varies by infection site. Sepsis-associated DIC may not represent a uniform entity across infection phenotypes. Further studies are needed to clarify site-specific risks and mechanisms to optimize treatment strategies.