Sepsis-induced coagulopathy and outcomes – What about bleeding? A propensity score-matched study in critically ill patients with septic shock

Sepsis-induced coagulopathy (SIC) is a scoring system developed for early detection of coagulopathy in sepsis and selection of patients for interventional studies. Our aim was to define the prevalence of SIC in a critically ill population and investigate if SIC at intensive care unit (ICU) admission is associated with morbidity and mortality. Patients admitted with septic shock between 2011, and March 2024 were propensity matched into 2 groups (control and SIC). Primary outcome was 28-day mortality. Other outcomes were 90-, 180-day and ICU-mortality, days alive and free of vasopressors, mechanical ventilation and renal replacement therapy (RRT) along with the use of RRT, number of critical bleeding events and red blood cell transfusion. 1367 patients with septic shock were identified, 422 (31%) had SIC at ICU admission. Propensity matching resulted in 340 patients in each group. SIC was not associated with higher 28-day mortality (44% versus 37%, p = 0.091). ICU-mortality was higher in the SIC group (30% versus 22%, p = 0.016) and it had fewer median days alive and free of vasopressors (20 versus 22, p = 0.046). Incidence of critical bleeding events was higher in the SIC group (17% versus 10%, p = 0.009). More patients in the SIC group required red blood cell transfusion (63% versus 53%, p = 0.009). There was no significant difference in other outcomes. SIC was prevalent in 31% of patients at ICU admission and was associated with higher ICU-mortality, fewer days alive and free of vasopressors, more critical bleeding events and more red blood cell transfusions. • SIC occurred in 31% of critically ill patients with septic shock. • SIC was not associated with 28-, 90-, or 180-day mortality, but was associated with higher ICU mortality. • SIC was associated with a higher risk of critical bleeding, RBC transfusion and fewer days alive and free of vasopressors.