Sepsis-associated coagulopathy in onco-hematology patients presenting with thrombocytopenia: a multicentric observational study

Abstract

Coagulation disorders increase mortality rate during septic shock, but the impact of concomitant hematological malignancies remains unknown. The study assessed coagulation disorders in onco-hematological patients with thrombocytopenia (<100 G/L) admitted to ICU for septic shock. Among 146 included patients, 50 patients had lymphoma and 49 patients had acute leukemia. ICU mortality rate was 43.8% (n = 64). Median increase in prothrombin time (PT) at day(d) 1 was 4.7 s (IQR 3.2–7.9) in ICU survivors vs. 6.4 s (IQR 4.5–13.7; p < 0.01) in non-survivors. Fibrinogen kinetics (increase in fibrinogen levels between d1 and d2) was +0.55 (−0.22–1.55) vs. +0.10 g/L (−0.40–0.50; p = 0.03) in surviving and non-surviving patients, respectively. PT increase ≥6 s at d1 (OR 5.5; 95% CI 1.1–6.0; p = 0.03) and mechanical ventilation (OR 7.4; 95% CI 3.3–17.7; p < 0.001) were independently associated with ICU mortality. This study provides information and new ways to identify hematological patients with high-risk mortality.

Keywords:

• (MeSH terms): sepsis
• disseminated intravascular coagulation
• intensive care unit
• hematologic neoplasms
• thrombocytopenia

Author contributions

VL, AM, LZ, LM, MD and RCJ participated in the writing and editing of the manuscript. VL, DM, FP, AK, JM, FB, PP, APM, ASM, DB and MD included the patients.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

TrialOH cohort was supported by the French Society for Critical Care and the French Ministry of health under Grant PHRC AOM 08235.