Frontiers in cellular and infection microbiology · 2026
Longitudinal sepsis-induced coagulopathy score trajectories and mortality in relation to early prophylactic heparin: a multicentre cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Cao Yuan, Wang Min, Li Yun, Shi Shaoqing, Wang Chengjin, Wu Yiqi, Gao Zhen, Wang Lu, Liu Yuyan, Kang Hongjun
Аннотация
BACKGROUND: Sepsis-induced coagulopathy (SIC) evolves dynamically, and a single-timepoint score may not capture its longitudinal course. This study characterised SIC score trajectories, evaluated their associations with mortality, and conducted exploratory analyses of early prophylactic unfractionated heparin exposure.
METHODS: SIC score trajectories were characterised using a latent class mixed model. Trajectory-class prediction models were developed from baseline features within the first 24 hours of ICU admission using five algorithms. Heparin analysis used a 48-hour landmark design; weighted Fine-Gray models and cumulative incidence functions estimated 28-day post-landmark in-hospital mortality.
RESULTS: The study enrolled 20,168 patients from MIMIC-IV and 5,829 from eICU-CRD. Three SIC trajectories were identified-Persistently High, Rising-then-Falling, and Resolving-comprising 31.9%, 10.6%, and 57.5% of patients in MIMIC-IV and 49.1%, 7.2%, and 43.7% in eICU-CRD. Relative to the Resolving trajectory, adjusted subdistribution hazard ratios (sHR) for mortality were 1.65 (95% CI 1.52-1.78) and 1.33 (1.18-1.49) for Persistently High and Rising-then-Falling in MIMIC-IV, and 1.73 (1.51-1.99) and 1.67 (1.33-2.11) in eICU-CRD. Prophylactic heparin was associated with a lower subdistribution hazard of 28-day post-landmark mortality in MIMIC-IV (sHR=0.908, 95% CI 0.839-0.983, P = 0.018); in an exploratory interaction analysis, the point estimate was more pronounced at higher predicted probabilities of the Persistently High trajectory, but this pattern was not replicated in eICU-CRD (sHR 0.877, 95% CI 0.744-1.034, P = 0.118).
CONCLUSION: SIC score trajectories stratify septic patients into three trajectory classes-Persistently High, Rising-then-Falling, and Resolving-each showing a graded association with 28-day mortality. Early prophylactic unfractionated heparin showed an exploratory association with lower post-landmark mortality in MIMIC-IV that was not independently replicated in eICU-CRD. Although these findings do not support treatment recommendations or trajectory-based anticoagulation decisions, they provide a basis for formulating hypotheses for future prospective studies.
METHODS: SIC score trajectories were characterised using a latent class mixed model. Trajectory-class prediction models were developed from baseline features within the first 24 hours of ICU admission using five algorithms. Heparin analysis used a 48-hour landmark design; weighted Fine-Gray models and cumulative incidence functions estimated 28-day post-landmark in-hospital mortality.
RESULTS: The study enrolled 20,168 patients from MIMIC-IV and 5,829 from eICU-CRD. Three SIC trajectories were identified-Persistently High, Rising-then-Falling, and Resolving-comprising 31.9%, 10.6%, and 57.5% of patients in MIMIC-IV and 49.1%, 7.2%, and 43.7% in eICU-CRD. Relative to the Resolving trajectory, adjusted subdistribution hazard ratios (sHR) for mortality were 1.65 (95% CI 1.52-1.78) and 1.33 (1.18-1.49) for Persistently High and Rising-then-Falling in MIMIC-IV, and 1.73 (1.51-1.99) and 1.67 (1.33-2.11) in eICU-CRD. Prophylactic heparin was associated with a lower subdistribution hazard of 28-day post-landmark mortality in MIMIC-IV (sHR=0.908, 95% CI 0.839-0.983, P = 0.018); in an exploratory interaction analysis, the point estimate was more pronounced at higher predicted probabilities of the Persistently High trajectory, but this pattern was not replicated in eICU-CRD (sHR 0.877, 95% CI 0.744-1.034, P = 0.118).
CONCLUSION: SIC score trajectories stratify septic patients into three trajectory classes-Persistently High, Rising-then-Falling, and Resolving-each showing a graded association with 28-day mortality. Early prophylactic unfractionated heparin showed an exploratory association with lower post-landmark mortality in MIMIC-IV that was not independently replicated in eICU-CRD. Although these findings do not support treatment recommendations or trajectory-based anticoagulation decisions, they provide a basis for formulating hypotheses for future prospective studies.