Sepsis-related coagulation-inflammation score: Development and validation for predicting 28-day mortality in patients with sepsis

Abstract

Background

Sepsis remains a leading cause of mortality in intensive care units worldwide, characterized by dysregulated host response to infection involving complex interactions between coagulation and inflammatory pathways. Current prognostic tools have limitations in capturing this pathophysiological interplay. This study aimed to develop and validate a novel Sepsis-related Coagulation-Inflammation Score (SCIS) to predict 28-day mortality in sepsis patients.

Methods

We conducted a retrospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 criteria at a tertiary medical center between January 2017 and December 2022. Demographic data, clinical characteristics, coagulation parameters (platelet count, prothrombin time, activated partial thromboplastin time, D-dimer, fibrinogen), and inflammatory markers (C-reactive protein, procalcitonin, interleukin-6, white blood cell count, neutrophil-to-lymphocyte ratio) were collected. Univariate and multivariate logistic regression analyses identified significant predictors of 28-day mortality. The SCIS was developed by assigning weighted points to independent predictors. Receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis evaluated the score's predictive performance and clinical utility. The score was compared with established sepsis severity scores including SOFA, APACHE II, and DIC scores.

Results

Among 578 sepsis patients, 28-day mortality was 32.7 %. The final SCIS incorporated five parameters: platelet count, D-dimer, prothrombin time, procalcitonin, and interleukin-6. The SCIS demonstrated excellent discriminative ability for predicting 28-day mortality (AUC 0.86, 95 % CI 0.83–0.89), superior to SOFA (AUC 0.79), APACHE II (AUC 0.77), and DIC score (AUC 0.74). The score maintained robust performance across subgroups stratified by infection site, comorbidities, and organ dysfunction. A SCIS ≥10 was associated with a 5.8-fold increased risk of 28-day mortality (95 % CI 4.2–7.9, p < 0.001).

Conclusion

The Sepsis-related Coagulation-Inflammation Score effectively integrates coagulation and inflammatory parameters to predict 28-day mortality in sepsis patients. This novel scoring system provides enhanced prognostic accuracy compared to established scores and may facilitate early risk stratification, therapeutic decision-making, and resource allocation in sepsis management.