Abnormal Coagulation Tests Obtained in the Emergency Department are Associated with Mortality in Patients with Suspected Infection

• Published in: The Journal of emergency medicine 2012-02, Vol.42 (2), p.127-132
• Main Authors: Fischer, Christopher M., MD, Yano, Kiichiro, PHD, Aird, William C., MD, Shapiro, Nathan I., MD, MPH
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Blood Coagulation Tests - methods; coagulation; Emergency; Emergency Service, Hospital - statistics & numerical data; Female; hematology; Hospital Mortality; Hospitals, University - statistics & numerical data; Hospitals, Urban - statistics & numerical data; Humans; infection; Infection - blood; Infection - mortality; Male; Middle Aged; Multiple Organ Failure - blood; Multiple Organ Failure - mortality; Odds Ratio; Predictive Value of Tests; Prospective Studies
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2010.05.007

Abstract Background: Early recognition of acute organ dysfunction in emergency department (ED) patients with suspected infection may help select patients at increased risk of mortality. The hematologic system is often overlooked in the evaluation and management of patients with infection because it is poorly circumscribed and serves a multitude of functions. Study Objectives: We examine the hypothesis that abnormalities in commonly and easily obtained markers of coagulation function (international normalized ratio [INR], partial thromboplastin time [PTT], and platelet count [PLT]) are associated with mortality in ED patients admitted to the hospital with suspected infection. Methods: Design: Secondary analysis of a prospective observational cohort study. Setting: Urban tertiary care university hospital with 50,000 annual ED visits. Patients: Included patients: adults (age 18 ≥ years) evaluated in the ED for a suspected infection, had an INR, PTT, and PLT obtained during the ED stay, admitted to the hospital. Excluded patients: on oral anticoagulant therapy, received heparin, or pre-existing severe liver disease. Results: There were 1688 patients included. The in-hospital mortality rate was 5.9%. After adjusting for elderly status, comorbid illness burden, and severity of illness, elevated INR was associated with a 2.9 (95% confidence interval [CI] 1.6–5.2) increased odds of death, and a low platelet count (< 150,000/uL) was associated with 2.0 (95% CI 1.2–3.3) increased odds of death. The C-statistic for the model was 0.80. Conclusion: We found an independent association between abnormalities in the coagulation system and mortality in ED patients with suspected infection. These findings underscore the close interaction between inflammation and coagulation and provide evidence that these simple laboratory tests should be routinely considered during the early evaluation of the infected patient.