Sepsis-induced coagulopathy in blood cancer patients with infectious complications: 616.15-008.1:616.15-07

Abstract

Summary. Introduction. Patients with blood cancer are at high risk of developing infectious complications and sepsis. Coagulopathy is usually detected in 50–70% of patients with sepsis. Sepsis-induced coagulopathy (SIC) may determine treatment outcomes for patients with blood cancer. Aim: to assess the SIC impact on the treatment outcomes of blood cancer patients. Materials and Мethods. A retrospective analysis was conducted using the data of 267 blood cancer patients with infectious complications and sepsis hospitalized in the intensive care unit. Patient’s clinical data, results of clinical blood test, biochemical and coagulation tests, cytokine levels, and thromboelastography (TEG) results were assessed. The severity of organ dysfunction was assessed using the Sequential Organ Failure Assessment (SOFA) scale. SIC presence was determined in accordance with the criteria proposed by T. Iba et al. (2017). Results. SIC was diagnosed in 151 of 267 (56.6%) patients. A decrease in the survival rate of patients with SIC was observed among patients without SIC compared to those without SIC (Logrank χ2 = 28.9; p < 0.001). SIC was associated with an increased prevalence of consciousness impairment (odds ratio (OR) = 4.88; 95% confidence interval (CI) = 1.97–12.07; p < 0.001), as well as a reduction in urine output to less than 35 mL/hour (OR = 6.35; 95% CI = 2.4–16, 77; p < 0.001), septic shock (OR = 13.68; 95% CI = 3.20–58.43%; p < 0.001). Furthermore, the frequency of invasive mechanic al ventilation use was 3.28 times higher in patients with SIC (OR = 3.28; 95% CI = 1.73–6.23; p < 0.001). Assessment of coagulation changes revealed both hypercoagulable (increased levels of fibrinogen, von Willebrand factor and factor VIII activity), and hypocoagulable changes (increasing of activated partial thromboplastin time, prothrombin time; prolongation of R and K intervals, decreasing angle α and maximum amplitude according to TEG). Conclusion. SIC in patients with blood cancer has been demonstrated to elevate the inci- dence of organ dysfunction and septic shock, significantly increasing mortality. The challenge of managing SIC correcting is attributed to the ambivalent coagulological alterations.

For citation: Lyanguzov A. V., Bulanov A.Yu., Ignatyev S. V., Nazarova E. L., Kalinina S. L., Sergunina O.Yu., Zorina N. A., Paramonov I. V. Sepsis-induced coagulopathy in blood cancer patients with infectious complications. Tromboz, gemostaz i reologiya. 2024;(4):20–28. (In Russ.).

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