Journal of Clinical Medicine
Dynamic Coagulation Deterioration and Cumulative Burden Preceding Noncoagulation Organ Dysfunction in Sepsis: A Two-Database Cohort Study
By Xiang Li, Jingjing Dai, Xilei Cai and 3 others.
Abstract
Background
Static coagulation measurements cannot distinguish transient fluctuation from sustained abnormality in sepsis. We assessed whether 0–24 h dynamic coagulation phenotypes preceded noncoagulation organ dysfunction during 24–72 h.
Methods
We conducted a retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV) for development and the eICU Collaborative Research Database (eICU-CRD) for component-level replication. Platelet count, international normalized ratio (INR) and partial thromboplastin time (PTT) were aligned to fixed 6 h grids. The two-marker coagulation deterioration index (CDI2) was the prespecified primary exposure; coagulation instability, recovery and cumulative coagulation burden (CCB) were prespecified secondary phenotypes. Modified Poisson models estimated adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). Trajectories incorporating measurements after 24 h were excluded from temporally ordered association and prediction models.