The prognostic value of an integrated inflammatory and complement biomarker panel for early prediction of sepsis induced disseminated intravascular coagulation

Abstract

Abstract Background Sepsis-associated disseminated intravascular coagulation (DIC) is a severe and rapidly progressive complication that markedly increases mortality. Because DIC lacks specific clinical manifestations in its early stage and conventional coagulation parameters show only limited changes at disease onset, early prediction in clinical practice remains challenging. Inflammatory responses, infectious burden, and aberrant activation of the complement system are recognized as key pathological mechanisms underlying coagulation imbalance in sepsis. However, the potential value of multidimensional combined indicators for the early prediction of DIC has not been fully elucidated. Method In this retrospective cohort study, 133 adult patients with Sepsis-3–defined sepsis were enrolled and classified into DIC ( n = 47) and non-DIC ( n = 86) groups according to ISTH criteria. Admission clinical data, inflammatory markers (CRP, PCT, IL-6), and complement components (C3, C4) were collected. Logistic regression, ROC curve analysis, and decision curve analysis (DCA) were used to assess predictive performance, with internal validation of the combined model performed by bootstrap resampling. Results Patients in the DIC group had significantly higher SOFA scores and 28-day mortality than those in the non-DIC group ( p < 0.001). Serum levels of PCT and IL-6 were markedly elevated in the DIC group, whereas complement components C3 and C4 were significantly reduced ( p < 0.001). Multivariable analysis identified IL-6, PCT, C3, and C4 as independent predictors of DIC ( p < 0.05). The combined model incorporating all four biomarkers achieved an AUC of 0.915 (95% CI, 0.854–0.956), with a sensitivity of 78.72% and a specificity of 93.02%, outperforming any single marker alone. Internal validation using bootstrap resampling further confirmed the robust predictive performance of the combined model. Conclusion CRP, PCT, IL-6, C3, and C4 may serve as potential biomarkers for the early prediction of sepsis-associated DIC. The combined use of these four indicators demonstrates good predictive performance, facilitating early identification of high-risk patients and thereby providing a reference for timely intervention and prognosis improvement.