PURPOSE: Abnormal coagulapathies are commonly encountered by patients admitted to intensive care units (ICU). Although previous data indicate that patients receiving blood product transfusions have suboptimal outcomes, these products are often required in the treatment of coagulopathic patients. There is minimal data on the morbidity and mortality implications of an abnormal International Normalized Ratio (INR) value.
METHODS: Retrospective data were collected on 1272 patients admitted to a Level I trauma center intensive care unit over a one-year period. Baseline data including APACHE II scores and INR values were collected at the time of ICU admission. Relative in-hospital events were captured for the remaining hospital course. Patients were stratified into either a survivor cohort or a non-survivor cohort for data analysis.
RESULTS: Nine hundred twenty-seven patients met inclusion criteria and had an INR value measured within four hours of ICU admission. A total of 103 patients (11.1%) died during hospitalization. The average INR for individuals in the non-survivor cohort was 2.25 compared to 1.30 for the survivor cohort. Overall, 162 patients (17.5%) had an INR value greater than 1.5: the mortality rate in these individuals was higher than those with INR values less than 1.5 (21.0 vs. 9.7%). Patients with INR values greater than 1.5 had longer hospital and ICU lengths of stay (12.0 vs. 11.1 days and 6.9 vs. 6.0 days respectively). Coagulopathic patients also received more blood products (2.6 vs. 1.4 units of packed red cells, 3.2 vs. 0.5 units of frozen plasma, 7.7 vs. 2.1 mg vitamin K, and 228 vs. 58 units of recombinant factor VII).
CONCLUSION: Abnormal INR upon admission to the ICU is associated with increased mortality, prolonged hospitalization and greater consumption of blood products.
CLINICAL IMPLICATIONS: Initial assessment of an INR value upon ICU admission may serve clinicians as a prognostic tool in the care of critically-ill patients.
DISCLOSURE: Gregory Peitz, No Financial Disclosure Information; No Product/Research Disclosure Information