Combination of antithrombin and soluble thrombomodulin for early prediction of sepsis-Induced disseminated intravascular coagulation

BACKGROUND: To identify early diagnostic biomarkers for sepsis-induced disseminated intravascular coagulation, we investigated the relationship between the novel coagulation biomarkers and antithrombin with the development of Disseminated intravascular coagulation post-admission, as well as the prognosis of patients with sepsis.

METHODS: We retrospectively collected data from septic patients admitted to the Emergency Intensive Care Unit (EICU) of a teaching hospital between October 2021 and September 2023. Multivariate logistic regression analysis was performed to identify risk factors, and receiver operating characteristic (ROC) curve analysis was used to assess the performance of the predictive model. In addition, non-parametric bootstrap analysis with 1,000 replications was conducted to evaluate the internal stability and empirical power of the predictive models, particularly given the limited sample size.

RESULTS: Among 91 septic patients, 15 were diagnosed with DIC. Soluble thrombomodulin (OR: 1.28, 95% CI: 1.033-1.586, P = 0.024) and antithrombin activity (OR: 0.887, 95% CI: 0.792-0.994, P = 0.039) were identified as independent risk factors for the development of DIC in septic patients. The area under the curve (AUC) for soluble thrombomodulin and antithrombin was 0.788 and 0.757, respectively. When combined, the AUC increased to 0.858. Prothrombin Time (HR: 1.058, 95% CI: 1.016-1.102, P = 0.007) and APACHE II score (HR: 1.071, 95% CI: 1.005-1.141, P = 0.035) were identified as independent risk factors for 28-day mortality in septic patients. When combined, the AUC increased to 0.834. Bootstrap validation demonstrated strong discriminatory performance of both models, with a mean bootstrap AUC of 0.865 (empirical power = 0.994) for the DIC prediction model, and 0.836 (empirical power = 0.996) for the 28-day mortality model, further supporting the robustness and reliability of the findings despite the small sample size.

CONCLUSION: Elevated soluble thrombomodulin and decreased antithrombin may be associated with the early onset of disseminated intravascular coagulation in sepsis, but showed limited predictive value for 28-day mortality.