Sepsis-induced coagulopathy (SIC) is a scoring system developed for early detection of coagulopathy in sepsis and selection of patients for interventional studies. Our aim was to define the prevalence of SIC in a critically ill population and investigate if SIC at intensive care unit (ICU) admission is associated with morbidity and mortality. Patients admitted with septic shock between 2011, and March 2024 were propensity matched into 2 groups (control and SIC). Primary outcome was 28-day mortality. Other outcomes were 90-, 180-day and ICU-mortality, days alive and free of vasopressors, mechanical ventilation and renal replacement therapy (RRT) along with the use of RRT, number of critical bleeding events and red blood cell transfusion. 1367 patients with septic shock were identified, 422 (31%) had SIC at ICU admission. Propensity matching resulted in 340 patients in each group. SIC was not associated with higher 28-day mortality (44% versus 37%, p=0.091). ICU-mortality was higher in the SIC group (30% versus 22%, p=0.016) and it had fewer median days alive and free of vasopressors (20 versus 22, p=0.046). Incidence of critical bleeding events was higher in the SIC group (17% versus 10%, p=0.009). More patients in the SIC group required red blood cell transfusion (63% versus 53%, p=0.009). There was no significant difference in other outcomes. SIC was prevalent in 31% of patients at ICU admission and was associated with higher ICU-mortality, fewer days alive and free of vasopressors, more critical bleeding events and more red blood cell transfusions.

Sepsis remains a leading cause of mortality in intensive care units (ICU), but optimal energy delivery strategies remain unclear. This post hoc analysis examines the association between early energy delivery and 28-day all-cause mortality in ICU patients with sepsis. This post hoc analysis of the multicentre NEED trial (ISRCTN12233792) included ICU patients with sepsis and≥7-day stays. Early energy delivery (first 7days) was calculated as a percentage of the target 25kcal/kg ideal body weight. Patients were stratified by mNUTRIC score (<5 vs ≥5). Associations with 28-day mortality were assessed using Cox models and Kaplan-Meier analysis, with subgroup and spline analyses exploring effect modification and nonlinearity. This analysis included 1162 sepsis patients (median age 66.0years, 66.3% male), with 183 (15.7%) patients deceased within 28-day after ICU admission. The optimal energy delivery thresholds were identified as 100% of the target for low-risk and 60% for high-risk patients. Cox proportional hazards models further confirmed that in the high-risk group, achieving≥60% of the target was associated with a lower 28-day mortality risk (hazard ratio=0.588, 95% conficence interval: 0.388-0.891), whereas no benefit was observed in low-risk patients. Additionally, no significant interactions were found in subgroup analyses. Restricted cubic spline analysis suggested a downward trend in mortality risk with increasing energy delivery in high-risk patients (P-nonlinear=0.063). Early energy delivery ≥60% of target is linked to lower 28-day mortality in high-risk sepsis patients, with no clear benefit in low-risk groups. These results support risk-based nutritional strategies in sepsis care. ISRCTN 12233792, registered on November 24, 2017.

Bleeding events are common during the provision of Venoarterial ECMO (VA ECMO). Previous observational has suggested that these bleeding events are associated with an increased risk of in-hospital mortality however data on long term mortality and functional outcomes are lacking. This multi-centre prospective observational study included patients enrolled in the EXCEL registry from February 2019 until June 2023. We collected baseline demographics, and details of ECMO support. The primary outcome was a composite of death or new disability (defined as an increase of ≥10%. in the world health organization disability assessment schedule score) at 180days after ECMO initiation. We used multivariable logistic and quantile regression adjusted for illness severity and patient characteristics and diagnosis to assess the association of bleeding with death and new disability and other functional and clinical outcomes. The final study cohort included 704 participants, median [interquartile range IQR] age 54.5 [42 to 64] years and 259 (36.8%) were female. Bleeding complications occurred in 312 (44.3%) participants and 154 (22.3%) had major bleeding. Patients with bleeding complications were more often receiving VA ECMO for peri-operative support [112 (36.4%) vs (73 (19.3%), p<0.001). Patients who experienced bleeding complications were at significantly increased risk of the primary outcome at 6months risk difference (RD) 8.95% (95% CI: 1.62 to 16.14). However, this finding was due to a significantly increased risk of new disability- adjusted RD 18.04% (95% CI: 6.22 to 29.55) rather than an increased risk of mortality in patients with bleeding compared to no bleeding [adjusted RD 5.71% (95% CI: -1.55 to 13.01)]. Patients with bleeding complications were also associated with an increased use of healthcare resources such as ICU length of stay and renal replacement therapy. Bleeding increased the rate of death and disability at 6-months, but this was driven by increased disability rather mortality. Bleeding complications were associated with an increased use of healthcare resources. Prospective studies to address modifiable risk factors for bleeding complications are warranted.