Prolonged prothrombin time (PT) in patients admitted to the intensive care unit (ICU) with sepsis was found to be associated with activation of coagulation and disturbances in host response mechanisms, according to research published in the Journal of Thrombosis and Haemostasis.
PT is often used to identify coagulation abnormalities in critically ill patients, particularly those with sepsis. PT may be a risk factor for death in patients in the ICU with severe sepsis.
The study authors sought to understand the association between consumptive coagulopathy and host response aberrations in ICU patients with sepsis. They used prolonged PT and measurement of 19 biomarkers to indicate coagulation activation.
The study was a prospective, observational study conducted in the ICUs of 2 tertiary teaching hospitals. Over a 3-year period, 1524 sepsis admissions with PT measurements within 24 hours after admission were included in the study. Patients were divided into quartiles: normal PT, slightly prolonged PT, intermediately prolonged PT, and extremely prolonged PT levels.
Patients with extremely prolonged PT tended to have comorbidities, be sicker, and have longer duration of ICU stay than patients in the other quartiles.
The study authors also stratified patients by platelet count. The patients with very low platelet counts (<50 x 109L) had the highest ICU mortality at 34.6% compared with patients with higher platelet counts. Patients with prolonged PT tended to have the lowest platelet counts, but prolonged PT on admission decreased during the first 7 days after admission.
The authors evaluated a subgroup of patients with sepsis and definite or probable likelihood of infection. They measured host response biomarkers and found that patients with extremely prolonged PT had signs of severe coagulation disorders. Patients with extremely prolonged PT also had signs of a more disturbed endothelial barrier function and enhanced systemic inflammation.
When controlling for confounding factors, such as disease severity, the authors did not find an independent association between PT at admission and death. When matched for disease severity, platelet counts were similar between patients with extremely prolonged PT and those with normal PT.
A prolonged PT is associated with anomalies in pathways implicated in the pathogenesis of sepsis. The authors concluded that activation of coagulation affects host response mechanisms in sepsis; however, causality cannot be inferred through this observational study.
van Vught LA, Uhel F, Ding C, et al. Consumptive coagulopathy is associated with a disturbed host response in patients with sepsis. J Thromb Haemost. Published online January 21, 2021. doi:10.1111/jth.15246. doi:10.1111/jth.15246