Severity of sepsis-associated coagulopathy predicts hospital mortality

This study outlines a simplified classification scheme for coagulopathy with implications that are potentially “profound,” according to authors of an editorial accompanying the journal article.

“Despite the frequency with which hemostatic derangements occur in sepsis, there has not been a widely accepted system for stratification of coagulopathies,” said editorialists Garrett W. Britton, DO, Cody Babcock, PharmD, and Christopher J. Colombo, MD. “Of the most cited criteria, all have varying concordance, and one does not seem to have an advantage over another.”

In the present study, patients with sepsis-associated coagulopathy were stratified into mild, moderate, and severe categories based on international normalized ratio (INR) levels and platelet counts.

While the study has limitations including a sicker patient cohort and arbitrarily chosen severity thresholds, the investigators did find progressively increasing mortality rates that correlated with severity and were independent of confounding variables.

“Overall, this stratification system will prove useful in identifying target populations in future interventional studies,” the editorial authors wrote.

Since sepsis-related mortality remains high, the ultimate goal of research should be identifying varying phenotypes of the disease and targeting them with specific therapies, they added.

“Lyons et al. have aided the first steps in that process with their straightforward classification scheme for sepsis-associated coagulopathy,” they wrote. “Intelligently designed therapeutic trials ‘evaluating’ the response of these phenotypes to new (or old) pharmacotherapy should be the ultimate goal.”

Garrett W. Britton, DO, is with the department of medicine, critical care section, Walter Reed National Military Medical Center, Bethesda, Md. Cody Babcock, PharmD, and Christopher J. Colombo, MD, are with the department of medicine, critical care section, Dwight David Eisenhower Army Medical Center, Fort Gordon, Ga. These comments are derived from their editorial in Critical Care Medicine . The authors had no disclosures beyond reporting government work.