Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2021; 9(25): 7405-7416
Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7405
Role of international normalized ratio in nonpulmonary sepsis screening: An observational study
Jing Zhang, Hui-Min Du, Ming-Xiang Cheng, Fa-Ming He, Bai-Lin Niu
Jing Zhang, Fa-Ming He, Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Hui-Min Du, Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Ming-Xiang Cheng, Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Bai-Lin Niu, Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Niu BL contributed to the study conception and design; Zhang J, Du HM, Cheng MX and He FM contributed to data collection and analysis; Zhang J and Du HM wrote the first draft of the manuscript; Niu BL further polished the manuscript and authorized the publication of the manuscript; Zhang J, Du HM and Cheng MX contributed equally to this work.
Supported by the Joint Scientific Research Project of Chongqing Science and Technology Commission and Health Commission, No. 2019MSXM019 and No. 2021MSXM033; Natural Science Project of Science and Technology Department of Tibet Autonomous Region, No. XZ2019ZR-ZY55(Z); Chongqing Natural Science Foundation Project, No. cstc2020jcyj-msxmX0124; and COVID-19 Emergency Projects of Chongqing Medical University, No. X1-2611.
Institutional review board statement: The study was reviewed and approved by the First Affiliated Hospital of Chongqing Medical University Ethics Committee (Approval No. 2019-312).
Informed consent statement: Informed consent to participate in this study which have been obtained from the research subjects prior to study commencement, and the study participants gave consent to have their data published. All informed consents are in the form of hand-signed consent forms by participants.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bai-Lin Niu, MD, Associate Professor, Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. nberlin@126.com
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: May 23, 2021
Revised: June 6, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: September 6, 2021
Abstract
BACKGROUND

Currently, there is a lack of sepsis screening tools that can be widely used worldwide. Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms, which usually rely less on screening tools.

AIM

To investigate the efficiency of the international normalized ratio (INR) for the early rapid recognition of adult nonpulmonary infectious sepsis.

METHODS

This is a prospective observational study. A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria. Commonly used clinical indicators, such as white blood cell, neutrophil count, lymphocyte count, neutrophil-lymphocyte count ratio (NLCR), platelets (PLT), prothrombin time, INR, activated partial thromboplastin time, and quick Sequential “Sepsis-related” Organ Failure Assessment (qSOFA) scores were recorded within 24 h after admission. The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis, Spearman correlation, and receiver operating characteristic curve analysis.

RESULTS

The INR value of the sepsis group was significantly higher than that of the nonsepsis group. INR has superior diagnostic efficacy for sepsis, with an area under the curve value of 0.918, when those preexisting diseases which significantly affect coagulation function were excluded. The diagnostic efficacy of the INR was more significant than that of NLCR, PLT, and qSOFA (P < 0.05). Moreover, INR levels of 1.17, 1.20, and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories: low, medium and high risk, respectively.

CONCLUSION

The INR is a promising and easily available biomarker for diagnosis, and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis. When its value is higher than the optimal cutoff value (1.22), high vigilance is required for adult nonpulmonary infectious sepsis.

Keywords: Sepsis, Coagulopathy, International normalized ratio, Screening tool, Quick Sequential “Sepsis-related” Organ Failure Assessment

Core Tip: The international normalized ratio (INR) has high specificity and sensitivity in the early identification of adult nonpulmonary source of sepsis. Sepsis is highly suspected when the INR value exceeds 1.22 in patients with non-pulmonary infection, especially for those patients without preexisting underlying disease or medication history that affects coagulation function. Due to its low cost, fast detection and easy interpretation, INR is suitable for the primary screening of sepsis for emergency patients, outpatient patients, particularly in low and middle-income countries.