The interplay between microcirculatory dysfunction and coagulopathy in patients with sepsis: An exploratory single-center observational study

Background Sepsis-induced coagulopathy (SIC) and microvascular dysfunction are hallmark features of sepsis, yet their relationship remains poorly understood. The primary aim of this study was to investigate whether early microvascular impairment can predict the presence/development of SIC. The secondary objective was to explore the relationship between SIC and the evolution of microvascular perfusion over the first 4 days. Methods Prospective observational study on 30 septic patients. Sublingual microcirculation (incident dark-field video-microscopy) was evaluated at day 0 and 4. Standard coagulation tests and thromboelastography were assessed daily. SIC was identified by a SIC score ≥ 4. Plasma syndecan-1 and thrombomodulin levels were measured on day 0. Results SIC was identified in 20 patients (66.7%) by day 4. On day 0, the microcirculation did not differ between SIC+ and SIC- patients. However those with lower baseline microvascular flow index (MFI <2.92) were more likely to develop SIC (82% vs 46%, p = 0.037). From Day 0 to Day 4, microvascular density (TVD, PVD) decreased in the SIC+ group but increased in the SIC- group (p for interaction <0.05). Baseline Syndecan-1 levels correlated negatively with the variation (Δ) in microvascular density. Correlations were found between Δ-microcirculatory parameters and Δ-coagulation markers, such as Δ-MFI and Δ-INR ( r = −0.516, p < 0.05) or Δ-TVD and Δ-platelets ( r = 0.442, p < 0.05). Conclusions The sublingual microcirculation on day 0 failed to predict the development of SIC. In longitudinal exploratory analysis, SIC was associated with a reduction in microvascular density from day 0 to day 4, although a causal relationship remains to be established.