Protein C as an Early Indicator of Severe Coagulopathy and Mortality in Patients with Sepsis

Abstract

Objective: To determine Protein C as a useful early predictor of severe coagulopathy and mortality.

Methodology: It was a prospective observational study conducted at Mayo Hospital and Chughtai Institute of Pathology, Lahore from January, 2023 till September, 2023. 87 Patients admitted in Intensive Care Unit (ICU) with sepsis according to Sequential Organ Failure Assessment Score (SOFA score >2 according to sepsis-3 criteria) and without overt DIC on ISTH criteria (ISTH score <5) were included in the study. Baseline levels of Protein C activity levels of 87 adult patients were taken at Day 0 of admission. Patients were followed till Day 3 for development of DIC and 28 days for mortality. According to the development of DIC at Day 3 patients were allocated into two groups: Overt-DIC Group (n=35) and Non-DIC Group (n=52).

Results: SOFA score and Protein C both showed positive correlation with DIC and mortality with p-value being <0.05. There was a significant difference in values of baseline Protein C activity in both groups p-value (0.00). The overall sensitivity of Protein C  was 90.4% ,specificity 71.4% ,Positive Predictive Value (PPV) 73% and Negative Predictive Value (NPV)  95% (CI 88.54-90.52%). Cut-off level was established for Protein C which was 52.9%.

Conclusion: Low Protein C activity levels alone on admission in hospital can effectively predict the evolution of severe coagulopathy (over-DIC) and mortality in patients with sepsis.