The Impact of Coagulopathy on Outcomes in Sepsis-Derived Acute Respiratory Distress Syndrome: A Sub-Analysis of the Focused Outcome Research on Emergency Care for Acute Respiratory Distress Syndrome, Sepsis and Trauma Study and the Sepsis Prognostication in Intensive Care Unit and Emergency Room Study

Background: The impact of coagulopathy to sepsis-induced acute respiratory distress syndrome (ARDS) outcomes remains poorly understood. This study aimed to investigate the relationships between coagulopathy and outcomes including mortality and oxygen recovery in septic patients with ARDS.Methods: Multicenter, prospective observational study in a subgroup of the FORECAST study (59 intensive care units (ICUs) from January 2016 to March 2017, UMIN000019742) and SPICE-ICU study (22 ICUs from December 2017 to May 2018, UMIN000027258) for severe sepsis and septic shock enrolled patients with sepsis-induced ARDS. The relationship between coagulopathy and in-hospital mortality was investigated in two studies. The impact of the coagulopathy criteria on oxygenation recovery was evaluated.Results: A total of 181 patients in the FORECAST study and 61 patients in the SPICE-ICU study with sepsis-induced ARDS were included. The odds ratio of coagulopathy for in-hospital mortality adjusted for confounding was 2.95 (95% CI, 1.23–7.07; p = 0.015) in the FORECAST study and 28.84 (95% CI, 1.93–431.10; p = 0.015) in the SPICE-ICU study. In both cohorts, 28-day mortality, ventilator-free days, and ICU-free days were all significantly lower in patients with coagulopathy. Although patients without coagulopathy had significant improvements in oxygenation over the first 4 days, patients with coagulopathy did not improve in oxygenation (ΔPaO2/FiO2 ratio, 24 ± 20 vs. 90 ± 9; p = 0.026).Conclusions: Coagulopathy was associated with increased mortality and delayed oxygenation recovery in sepsis-derived ARDS.