Correlation between sub-phenotypes of coagulopathy and prognosis in sepsis patients in ICU using longitudinal group trajectory modeling: a retrospective analysis

BACKGROUND: Coagulopathy is a common complication and heterogeneous syndrome of sepsis. Longitudinal data are essential for capturing the complexity and heterogeneity of coagulopathy in sepsis. The dynamic changes in coagulation profiles, their characterization, and prognostic implications remain poorly understood. We hypothesized that sepsis patients develop distinct coagulopathy sub-phenotypes. Using longitudinal data, we first aimed to identify these sub-phenotypes, then characterize their trajectories, and finally evaluate their association with 28-day mortality and explore potential influencing factors. METHODS: We conducted a retrospective analysis using Group-based Trajectory Modeling to investigate patterns of coagulation changes and their association with 28-day mortality in sepsis patients from West China Hospital of Sichuan University (2015-2022). The Cox proportional hazards regression model was used to investigate the relationship between trajectory groups and prognosis. Subgroup analyses were performed to explore potential influencing factors further. RESULTS: A total of 1649 patients were included, and 3 distinct trajectory sub-phenotypes were identified based on model fit indices and clinical interpretability. Group 1 (N = 818, 49.6%) exhibited the highest levels of D-dimer, a slight prolongation of clotting time, normal fibrinogen levels, and borderline-low platelet counts. Group 2 (N = 638, 38.7%) showed gradually increasing platelet counts, elevated fibrinogen levels, and normal clotting time. Group 3 (N = 193, 11.7%) displayed significantly prolonged clotting time, the lowest platelets and fibrinogen levels, and persistently high D-dimer levels. Group 2 showed lower 28-day mortality risk (HR 0.235, 95% CI 0.170-0.324) while Group 3 exhibited higher risk (HR 2.780, 95% CI 2.214-3.492) versus Group 1. Group 3 demonstrated the highest in-hospital mortality rates. Mechanical ventilation duration did not differ significantly across groups. Subgroup analysis identified an interaction between age and trajectory groups. CONCLUSIONS: Our study suggests that coagulopathy in sepsis patients can be classified into three distinct sub-phenotypes, each associated with different risks of 28-day mortality. Future prospective studies incorporating external validation and multiple specific parameters are needed to explore the mechanisms underlying these sub-phenotypes and validate their application in clinical practice.