Background: The coagulation cascade and inflammatory processes target damage in endothelial cells in sepsis-induced disseminated intravascular coagulation (DIC). This study aimed to measure levels of the molecular marker of endothelial injury, thrombomodulin, in patients with sepsis-induced DIC and to investigate potential relationships with poor clinical outcomes.
Methods: From October 2017 to October 2018, 45 patients with sepsis-induced DIC were recruited at Renmin Hospital of Wuhan University, in China. Concentrations of thrombomodulin and other routine coagulation and inflammatory factors were quantified.
Results: Thrombomodulin was present in the plasma of non-survivors at significantly higher levels than in the plasma of survivors (9.30 ± 1.56 vs. 5.54 ± 0.29 TU/mL, p < 0.05). Thrombomodulin showed an area under the curve of 0.87 for predicting mortality. The hazard function curve showed significantly higher mortality risk in patients with high thrombomodulin. Multiple linear regression demonstrated a positive correlation of plasma thrombomodulin with the Sequential Organ Failure Assessment (SOFA) score (β-coefficient = 0.610, p = 0.042). Logistic regression showed that thrombomodulin level was an independent risk factor for poor prognosis (OR 1.963, 95% CI 1.006 - 3.829). The nomogram based on thrombomodulin level and SOFA score revealed that an initial death risk probability can be established for patients with sepsis-induced DIC without further testing.
Conclusions: Elevated plasma thrombomodulin is associated with poor clinical outcomes in sepsis-induced DIC; therefore, a high plasma thrombomodulin level may be a useful prognostic factor.