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Routine coagulation tests on ICU admission are associated with mortality in sepsis : an observational study

Benediktsson, S. LU ; Frigyesi, A. LU and Kander, T. LU (2017) In Acta Anaesthesiologica Scandinavica 61(7). p.790-796
Abstract

Background: Low platelet count on admission to an intensive care unit (ICU) is associated with increased mortality and is thus included in some severity scoring systems such as the simplified acute physiologic score 3 (SAPS 3); however it is unclear whether other routine coagulation tests also predict mortality. The purpose of this retrospective single-centre study was to investigate whether activated partial thromboplastin time (APTT) or prothrombin time – international normalized ratio (PT-INR) measured on admission to the ICU in patients with severe sepsis or septic shock may be associated with mortality independent of SAPS 3 score. Methods: All patients admitted to a tertiary general ICU from 2007 to 2014 diagnosed with severe... (More)

Background: Low platelet count on admission to an intensive care unit (ICU) is associated with increased mortality and is thus included in some severity scoring systems such as the simplified acute physiologic score 3 (SAPS 3); however it is unclear whether other routine coagulation tests also predict mortality. The purpose of this retrospective single-centre study was to investigate whether activated partial thromboplastin time (APTT) or prothrombin time – international normalized ratio (PT-INR) measured on admission to the ICU in patients with severe sepsis or septic shock may be associated with mortality independent of SAPS 3 score. Methods: All patients admitted to a tertiary general ICU from 2007 to 2014 diagnosed with severe sepsis or septic shock were eligible. Results from APTT and PT-INR within 1.5 h of admission as well as SAPS 3 were used as independent variables in a Cox regression. Results: Of total 5485 ICU admissions during the study period we identified 647 unique patients with severe sepsis or septic shock. APTT and PT-INR were found to correlate significantly with mortality with a hazard ratio (HR) of 1.014 [95% confidence interval of HR (1.006–1.023)] for APTT and 1.422 (1.117–1.811) for PT-INR. HR for SAPS 3 was 1.036 (1.028–1.044). Conclusion: Activated partial thromboplastin time prolongation and raised PT-INR on ICU admission in patients with severe sepsis or septic shock is associated with increased mortality independent of SAPS 3 score. This indicates that APTT prolongation and PT-INR increase represents morbidity that is not accounted for in SAPS 3.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Anaesthesiologica Scandinavica
volume
61
issue
7
pages
7 pages
publisher
Wiley-Blackwell
external identifiers
  • scopus:85021706479
  • wos:000404981100011
ISSN
0001-5172
DOI
10.1111/aas.12918
language
English
LU publication?
yes
id
4f79fb3a-dbc2-4a4b-a268-fe2e7a647599
date added to LUP
2017-07-26 12:53:03
date last changed
2017-09-18 11:39:48
@article{4f79fb3a-dbc2-4a4b-a268-fe2e7a647599,
  abstract     = {<p>Background: Low platelet count on admission to an intensive care unit (ICU) is associated with increased mortality and is thus included in some severity scoring systems such as the simplified acute physiologic score 3 (SAPS 3); however it is unclear whether other routine coagulation tests also predict mortality. The purpose of this retrospective single-centre study was to investigate whether activated partial thromboplastin time (APTT) or prothrombin time – international normalized ratio (PT-INR) measured on admission to the ICU in patients with severe sepsis or septic shock may be associated with mortality independent of SAPS 3 score. Methods: All patients admitted to a tertiary general ICU from 2007 to 2014 diagnosed with severe sepsis or septic shock were eligible. Results from APTT and PT-INR within 1.5 h of admission as well as SAPS 3 were used as independent variables in a Cox regression. Results: Of total 5485 ICU admissions during the study period we identified 647 unique patients with severe sepsis or septic shock. APTT and PT-INR were found to correlate significantly with mortality with a hazard ratio (HR) of 1.014 [95% confidence interval of HR (1.006–1.023)] for APTT and 1.422 (1.117–1.811) for PT-INR. HR for SAPS 3 was 1.036 (1.028–1.044). Conclusion: Activated partial thromboplastin time prolongation and raised PT-INR on ICU admission in patients with severe sepsis or septic shock is associated with increased mortality independent of SAPS 3 score. This indicates that APTT prolongation and PT-INR increase represents morbidity that is not accounted for in SAPS 3.</p>},
  author       = {Benediktsson, S. and Frigyesi, A. and Kander, T.},
  issn         = {0001-5172},
  language     = {eng},
  month        = {08},
  number       = {7},
  pages        = {790--796},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Routine coagulation tests on ICU admission are associated with mortality in sepsis : an observational study},
  url          = {http://dx.doi.org/10.1111/aas.12918},
  volume       = {61},
  year         = {2017},
}