New Criteria for Sepsis-induced Coagulopathy (SIC) Following the Revised Sepsis Definition: a Retrospective Analysis of a Nationwide Survey

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 Oct 1

PMID 28963294

Citations 160

Authors

Toshiaki Iba

Marcello Di Nisio

Jerrold H Levy

Naoya Kitamura

Jecko Thachil

Affiliations

Soon will be listed here.

Abstract

Objective: Recent clinical studies have shown that anticoagulant therapy might be effective only in specific at-risk subgroups of patients with sepsis and coagulation dysfunction. The definition of sepsis was recently modified, and as such, old scoring systems may no longer be appropriate for the diagnosis of sepsis-associated coagulopathy. The aim of this study was to evaluate prognostic factors in patients diagnosed with sepsis and coagulopathy according to the new sepsis definition and assess their accuracy in comparison with existing models.

Design: Retrospective analysis of the nationwide survey for recombinant human soluble thrombomodulin.

Setting: General emergency and critical care centres in secondary and tertiary care hospitals.

Participants: We evaluated the prognostic value of the newly proposed diagnostic criteria for sepsis-induced coagulopathy (SIC). A total of 1498 Japanese patients with sepsis and coagulopathy complications who were treated with recombinant thrombomodulin were analysed in this study.

Main Outcome Measures: The platelet count, prothrombin time (PT) ratio, fibrinogen/fibrin degradation products, systemic inflammatory response syndrome score and Sequential Organ Failure Assessment (SOFA) score obtained just before the start of treatment were examined in relation to the 28-day mortality rate.

Results: The platelet count, PT ratio and total SOFA were independent predictors of a fatal outcome in a logistic regression model. A SIC score was defined using the three above-mentioned variables with a positivity threshold of 4 points or more. The SIC score predicted higher 28-day mortality rate compared with the current Japanese Association for Acute Medicine-disseminated intravascular coagulation score (38.4%vs34.7%).

Conclusion: The SIC score is based on readily available parameters, is easy to calculate and has a high predictive value for 28-day mortality. Future studies are warranted to evaluate whether the SIC score may guide the decision to initiate anticoagulant therapy.

Citing Articles

Impending sepsis-induced coagulopathy (SIC) is associated with increased disease severity in SIC-negative patients: a secondary analysis of a prospective exploratory study.

Schmoch T, Mohnle P, Nusshag C, Feisst M, Weigand M, Brenner T Front Med (Lausanne). 2025; 12:1525538.

PMID: 40034384 PMC: 11873100. DOI: 10.3389/fmed.2025.1525538.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.

Shime N, Nakada T, Yatabe T, Yamakawa K, Aoki Y, Inoue S Acute Med Surg. 2025; 12(1):e70037.

PMID: 39996161 PMC: 11848044. DOI: 10.1002/ams2.70037.

The diagnosis of DIC: a current overview.

Yang H, Ma X, Li X Front Med (Lausanne). 2025; 12:1502628.

PMID: 39958822 PMC: 11825743. DOI: 10.3389/fmed.2025.1502628.

Hyperferritinemia is Associated with Thrombocytopenia and Increased Mortality Risk in Adult Sepsis Patients: A Retrospective Study of Two Observational Cohorts.

Li D, Li X, Wen B, Li B, Wang Y, Zong Y Clin Appl Thromb Hemost. 2025; 31:10760296251321314.

PMID: 39957136 PMC: 11831685. DOI: 10.1177/10760296251321314.

The Mechanisms of Sepsis Induced Coagulation Dysfunction and Its Treatment.

Zhu L, Dong H, Li L, Liu X J Inflamm Res. 2025; 18:1479-1495.

PMID: 39925935 PMC: 11804232. DOI: 10.2147/JIR.S504184.

References

Gando S, Levi M, Toh C . Disseminated intravascular coagulation. Nat Rev Dis Primers. 2016; 2:16037. DOI: 10.1038/nrdp.2016.37. View

Hayakawa M, Yamakawa K, Saito S, Uchino S, Kudo D, Iizuka Y . Recombinant human soluble thrombomodulin and mortality in sepsis-induced disseminated intravascular coagulation. A multicentre retrospective study. Thromb Haemost. 2016; 115(6):1157-66. DOI: 10.1160/TH15-12-0987. View

Seong S, Matzinger P . Hydrophobicity: an ancient damage-associated molecular pattern that initiates innate immune responses. Nat Rev Immunol. 2004; 4(6):469-78. DOI: 10.1038/nri1372. View

Schouten M, Wiersinga W, Levi M, van der Poll T . Inflammation, endothelium, and coagulation in sepsis. J Leukoc Biol. 2007; 83(3):536-45. DOI: 10.1189/jlb.0607373. View

Gando S, Meziani F, Levi M . What's new in the diagnostic criteria of disseminated intravascular coagulation?. Intensive Care Med. 2016; 42(6):1062-4. DOI: 10.1007/s00134-016-4257-z. View

Liaw P, Ito T, Iba T, Thachil J, Zeerleder S . DAMP and DIC: The role of extracellular DNA and DNA-binding proteins in the pathogenesis of DIC. Blood Rev. 2016; 30(4):257-61. DOI: 10.1016/j.blre.2015.12.004. View

Taylor Jr F, Toh C, Hoots W, Wada H, Levi M . Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2002; 86(5):1327-30. View

Warren B, Eid A, Singer P, Pillay S, Carl P, Novak I . Caring for the critically ill patient. High-dose antithrombin III in severe sepsis: a randomized controlled trial. JAMA. 2001; 286(15):1869-78. DOI: 10.1001/jama.286.15.1869. View

Kadri S, Rhee C, Strich J, Morales M, Hohmann S, Menchaca J . Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data. Chest. 2016; 151(2):278-285. PMC: 5310115. DOI: 10.1016/j.chest.2016.07.010. View

10.

Kienast J, Juers M, Wiedermann C, Hoffmann J, Ostermann H, Strauss R . Treatment effects of high-dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation. J Thromb Haemost. 2006; 4(1):90-7. DOI: 10.1111/j.1538-7836.2005.01697.x. View

11.

Yamakawa K, Umemura Y, Hayakawa M, Kudo D, Sanui M, Takahashi H . Benefit profile of anticoagulant therapy in sepsis: a nationwide multicentre registry in Japan. Crit Care. 2016; 20(1):229. PMC: 4966726. DOI: 10.1186/s13054-016-1415-1. View

12.

Dhainaut J, Yan S, Joyce D, Pettila V, Basson B, Brandt J . Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost. 2004; 2(11):1924-33. DOI: 10.1111/j.1538-7836.2004.00955.x. View

13.

Vincent J, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter P . Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998; 26(11):1793-800. DOI: 10.1097/00003246-199811000-00016. View

14.

Levi M, ten Cate H . Disseminated intravascular coagulation. N Engl J Med. 1999; 341(8):586-92. DOI: 10.1056/NEJM199908193410807. View

15.

Yamakawa K, Ogura H, Fujimi S, Morikawa M, Ogawa Y, Mohri T . Recombinant human soluble thrombomodulin in sepsis-induced disseminated intravascular coagulation: a multicenter propensity score analysis. Intensive Care Med. 2013; 39(4):644-52. PMC: 3607733. DOI: 10.1007/s00134-013-2822-2. View

16.

Gando S, Iba T, Eguchi Y, Ohtomo Y, Okamoto K, Koseki K . A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. 2006; 34(3):625-31. DOI: 10.1097/01.ccm.0000202209.42491.38. View

17.

Umemura Y, Yamakawa K, Ogura H, Yuhara H, Fujimi S . Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: a meta-analysis of randomized controlled trials. J Thromb Haemost. 2015; 14(3):518-30. DOI: 10.1111/jth.13230. View

18.

Ranieri V, Thompson B, Barie P, Dhainaut J, Douglas I, Finfer S . Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012; 366(22):2055-64. DOI: 10.1056/NEJMoa1202290. View

19.

Esmon C, Xu J, Lupu F . Innate immunity and coagulation. J Thromb Haemost. 2011; 9 Suppl 1:182-8. PMC: 3151110. DOI: 10.1111/j.1538-7836.2011.04323.x. View

20.

Aikawa N, Shimazaki S, Yamamoto Y, Saito H, Maruyama I, Ohno R . Thrombomodulin alfa in the treatment of infectious patients complicated by disseminated intravascular coagulation: subanalysis from the phase 3 trial. Shock. 2010; 35(4):349-54. DOI: 10.1097/SHK.0b013e318204c019. View