Prognostic impact of sepsis-induced coagulopathy on mortality and clinical outcomes in ICU patients

Objective This study aimed to assess the prognostic impact of sepsis-induced coagulopathy (SIC) on mortality and clinical outcomes in patients with sepsis admitted to the intensive care unit (ICU). Materials and methods This retrospective cohort study included 1,305 adult patients with sepsis admitted to a tertiary pulmonary ICU between January 2016 and May 2025. SIC was defined using the International Society on Thrombosis and Haemostasis (ISTH) criteria, based on platelet (PLT) count, prothrombin time/international normalized ratio (PT/INR), and total Sequential Organ Failure Assessment (SOFA) score components. The primary outcome was in-hospital mortality, and secondary outcomes included vasopressor requirement, escalation to second-line vasopressor therapy, invasive mechanical ventilation (IMV), and continuous renal replacement therapy (CRRT). Multivariable logistic regression and receiver operating characteristic (ROC) analyses were conducted to assess the prognostic value of SIC. Results The prevalence of SIC was 19.2%. Patients with SIC had significantly higher in-hospital mortality than those without SIC (79.3% vs. 60.6%, p < 0.001). Vasopressor use and escalation to second-line vasopressor therapy were more frequent in the SIC-positive group (98.0% vs. 92.5%, p = 0.001; 45.8% vs. 31.3%, p < 0.001, respectively). In multivariable analyses, both SIC positivity (OR: 2.172, 95% CI: 1.528–3.087, p < 0.001) and the SIC score (OR: 1.324, 95% CI: 1.175–1.492, p < 0.001) were independently associated with mortality. ROC analysis showed that the SIC score had moderate discriminative performance for predicting mortality (AUC: 0.619, 95% CI: 0.588–0.649, p < 0.001), with an SIC score ≥ 4 identified as the clinically interpreted threshold. Conclusion SIC was independently associated with higher in-hospital mortality and greater need for vasopressor support in critically ill patients with sepsis. These findings suggest that SIC may provide complementary prognostic information when interpreted alongside established severity assessment tools; however, prospective studies are needed to clarify its clinical relevance and potential role in patient management.