{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T06:15:12Z","timestamp":1783318512885,"version":"3.54.6"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early identification of sepsis patients at high risk of multiple organ dysfunction syndrome (MODS) remains challenging. The Sepsis-Induced Coagulopathy (SIC) score does not incorporate age or vasopressor use, both strongly associated with organ failure progression. The Vasoactive-Age adjusted SIC (VAS) score integrates these dimensions, but its predictive value for new-onset MODS has not been systematically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-centre retrospective cohort study enrolled 495 adult sepsis patients (Sepsis-3.0 criteria) admitted between January 2019 and June 2023. Baseline VAS, SIC, Sequential Organ Failure Assessment (SOFA), 24-h worst SOFA (SOFA-2), Acute Physiology and Chronic Health Evaluation II (APACHE II), and quick SOFA (qSOFA) scores were calculated. The primary outcome was 28-day new-onset MODS. Predictive performance was compared using the area under the receiver operating characteristic curve (AUC) and the DeLong method. Cumulative incidence was estimated with Fine\u2013Gray competing-risk models. Independent predictors were identified by multivariable Cox regression. Net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis quantified incremental value. A nomogram was internally validated by 1,000-bootstrap resampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      New-onset MODS occurred in 148 patients (29.9%). The VAS score yielded an AUC of 0.777 [95% confidence interval (CI) 0.755\u20130.841], significantly higher than SIC (0.708,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and qSOFA (0.671,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), and comparable to SOFA (0.757,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.083). The optimal cut-off of VAS\u202f\u2265\u202f4 yielded 76.4% sensitivity and 73.2% specificity. After multivariable adjustment, VAS\u202f\u2265\u202f4 remained independently predictive of MODS [hazard ratio (HR) 3.42, 95% CI 2.31\u20135.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001], with significant interactions for age (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.024), septic shock (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.038), and SIC status (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.041). Adding lactate, procalcitonin, and N-terminal pro-B-type natriuretic peptide increased the AUC to 0.853 (NRI\u202f=\u202f0.124,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.012; IDI\u202f=\u202f0.086,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.021). A dynamic VAS increase (\u0394VAS&amp;gt;0) over 48\u202fh was independently associated with a 4.78-fold higher MODS risk (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The internally validated nomogram achieved a corrected C-index of 0.821.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The VAS score is a simple bedside tool that independently predicts 28-day new-onset MODS in sepsis, outperforming the SIC score and matching SOFA with fewer parameters. Combination with circulating biomarkers and dynamic \u0394VAS monitoring provides additional prognostic value and supports its integration into early sepsis risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1874204","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T05:37:26Z","timestamp":1783316246000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The vasoactive-age adjusted sepsis-induced coagulopathy score predicts 28-day new-onset multiple organ dysfunction syndrome in patients with sepsis: a single-centre retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Ke-jun","family":"Cao","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, The Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-qi","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, The Affiliated Hospital of Jiangnan University","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-zhi","family":"Fang","sequence":"additional","affiliation":[{"name":"Emergency Department, Jiangnan University Medical Center (JUMC)","place":["Wuxi, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the global burden of disease 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