Prognostic accuracy of SIC, JAAM DIC, and ISTH overt-DIC for 28-day all-cause mortality among patients with sepsis and coagulation abnormalities: a retrospective study

Background There is no gold standard for the diagnosis of coagulation dysfunction in sepsis, and the use of the current scoring systems is still controversial. The purpose of this study was to externally validate and assess the discriminatory capacities of SIC, JAAM DIC, and ISTH overt DIC for outcomes among patients with sepsis and coagulation abnormalities. Methods This retrospective study included patients with sepsis and coagulation abnormalities admitted to the general wards and ICU in Ruijin Hospital, Shanghai Jiaotong University School of Medicine from 2017 through 2019. The SIC, JAAM DIC, and ISTH overt-DIC criteria were applied to data collection during admission. The relationship between each scoring system and 28-day all-cause mortality was observed. Results Among 452 patients (mean age, 65 [48,76] years), 306 [66.7%] were men, the median SOFA score was 6 [4, 9], and the median APACHE II score was 15 [11, 22]. A total of 132 patients (29.2%) died within 28 days. SIC was positive in 25.4% of the patients, 44.7% of the patients manifested with JAAM DIC, and 12.2% had ISTH overt-DIC. Both the diagnosis of SIC (AUROC, 0.779 [95% CI, 0.728–0.830], P < 0.001) and ISTH overt-DIC (AUROC, 0.782 [95% CI, 0.732–0.833], P < 0.001) performed equally well in the discrimination of 28-day all-cause mortality (between-group difference: SIC vs. ISTH overt-DIC, -0.003 [95% CI, -0.025-0.018], P = 0.766). It is remarkably, however, the SIC demonstrated greater calibration for 28-day all-cause mortality than ISTH overt-DIC (the coincidence of the calibration curve of the former is higher than that of the latter). The diagnosis of JAAM DIC was not independently associated with 28-day all-cause mortality in sepsis (RR, 1.115, [95% CI 0.660–1.182], P = 0.684). Conclusions Combined with the results of distinction and calibration, the SIC scoring system demonstrated superior prognostic prediction ability for 28-day all-cause mortality among patients with sepsis and coagulation abnormalities than either JAAM DIC or ISTH overt-DIC. (309 words)