Chokri Ben Lamine: Sepsis Induced Coagulopathy Is Not a Single Disease Phenotype
Chokri Ben Lamine, Assistant Consultant at King Faisal Specialist Hospital and Research Center, shared a post on X about a recent article by Lu Wang et al., published in Thrombosis Journal:
“Sepsis-Induced Coagulopathy (SIC) is NOT one disease phenotype – major heterogeneity exists between INR-dominant vs platelet-dominant SIC.
Credits for sharing:
- Dr Ruaa Alyamany
- KFSHRC.
Key findings from Wang and Zhou, Thrombosis Journal 2026:
SIC incidence in sepsis reached 48.7%.
SIC-INR phenotype:
- Higher bilirubin
- Higher ALT
- More liver dysfunction
- More CRRT support
- Longer mechanical ventilation
- Longer hospital stay.
SIC-PLT phenotype:
- Lower fibrinogen
- Shorter APTT
- Lower lactate
- Lower glucose
- Less hepatic/renal dysfunction
- Shorter ventilation duration.
Pulmonary infection was the most common source of SIC (approximately 47%)․
DVT positivity in SIC reached approximately 22.9%․
SIC-INR had significantly higher DVT rates vs SIC-PLT․
- SIC-INR: 29.9%
- SIC-PLT: 19.1%․
Important concept:
Two patients may both fulfill SIC criteria but represent biologically different phenotypes with different organ dysfunction patterns and outcomes.
- SIC-PLT phenotype appears more hematopoietic/consumptive
- SIC-INR phenotype appears more hepatopathic/metabolic.
INR elevation in sepsis may reflect:
- Hepatic synthetic dysfunction
- Drug interactions
- Vitamin K alterations
- Severe inflammatory response.
Platelet-dominant SIC may reflect:
- Bone marrow suppression
- Platelet consumption
- Early consumptive coagulopathy.
Clinical implication:
- Future SIC trials and anticoagulation strategies should stratify by phenotype instead of treating SIC as a monolithic entity.
Another key pearl:
- Overall SOFA differences disappeared after excluding coagulation components → supporting true coagulation phenotype heterogeneity.
Mortality:
- No significant mortality difference in PUMCH cohort
- But lower mortality in SIC-PLT phenotype in MIMIC-IV validation cohort.
Intermuscular vein thrombosis was the most common DVT subtype in SIC patients.”
Title: Sepsis induced coagulopathy (SIC): is it monolithic?
Authors: Lu Wang, Xiang Zhou
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