Longitudinal sepsis-induced coagulopathy score trajectories and mortality in relation to early prophylactic heparin: a multicentre cohort study
In brief
Persistently high clotting scores tracked with higher sepsis mortality
In two ICU databases, patients with persistently high sepsis-related clotting scores had 33% to 73% higher adjusted mortality than those whose scores resolved; a rising-then-falling pattern was also linked to higher mortality. Preventive heparin was associated with lower mortality in one database, but the finding did not replicate in the other and does not support treatment decisions.
- Journal
- Frontiers in cellular and infection microbiology (Q1)
- Published
- 24 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Yuan Cao, Min Wang, Yun Li, Shaoqing Shi, Chengjin Wang, Yiqi Wu, et al.
- PMID
- 42851353
- DOI
- 10.3389/fcimb.2026.1923833
Why clinicians should know about it
- Picked for Critical Care and Intensive Care Medicine (paper of the day, 11 October 2026): SIC score trajectories predict mortality, sepsis focus
- Picked for Epidemiology (top studies of the week, 11 October 2026): SIC score trajectories cohort study
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.