{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:45:44Z","timestamp":1787028344939,"version":"build-2736575974"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T00:00:00Z","timestamp":1653782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Sepsis can affect various organs as well as the hematologic system. Systemic dysregulation, present in sepsis, affects particularly red blood cells (RBCs). One of the widely available RBC indices is RBC distribution width (RDW). Sepsis may also affect hemostasis, with septic patients presenting with coagulopathy or disseminated intravascular coagulation. The aim of our study was to analyze the impact of sepsis on RBC indices and coagulation parameters on admission to the intensive care unit (ICU) and their association with presence of sepsis and sepsis outcomes in anemic critically ill patients. We performed a retrospective observational study covering consecutive patients admitted to a 10-bed mixed ICU in the years 2020\u20132021. We found significant differences between septic and non-septic patients for the following parameters: RDW (p = 0.02), INR (p &lt; 0.01), aPTT (p &lt; 0.01), D-dimers (p &lt; 0.01), fibrinogen (p = 0.02), platelets (p = 0.04). International normalized ratio was the only parameter with adequate sepsis predictive value (AUROC = 0.70; 95% CI 0.63\u20130.76; p &lt; 0.01), with an optimal cut-off value of &gt;1.21. Combination of INR with fibrinogen and a severity of disease score improved INR\u2019s predictive value (AUROC 0.74\u20130.77). Combination of INR with a severity of disease score was an adequate ICU mortality predictor in septic patients (AUROC 0.70\u20130.75). Sepsis significantly affects RDW and most coagulation parameters. Increased INR can be used for sepsis screening, whereas combination of INR with a severity of disease score can be a predictor of short-term mortality in septic patients.<\/jats:p>","DOI":"10.3390\/ijerph19116626","type":"journal-article","created":{"date-parts":[[2022,5,29]],"date-time":"2022-05-29T08:50:51Z","timestamp":1653814251000},"page":"6626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Hematologic System Dysregulation in Critically Ill Septic Patients with Anemia\u2014A Retrospective Cohort Study"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4347-5631","authenticated-orcid":false,"given":"Piotr F.","family":"Czempik","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0533-163X","authenticated-orcid":false,"given":"Jan","family":"Herzyk","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawid","family":"Wilczek","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Society, Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5252-8398","authenticated-orcid":false,"given":"\u0141ukasz J.","family":"Krzych","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1007\/s00134-020-06151-x","article-title":"Incidence and mortality of hospital- and ICU-treated sepsis: Results from an updated and expanded systematic review and meta-analysis","volume":"46","author":"Mellhammar","year":"2020","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1164\/rccm.201504-0781OC","article-title":"Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations","volume":"193","author":"Fleischmann","year":"2016","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1097\/01.CCM.0000217961.75225.E9","article-title":"Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock","volume":"34","author":"Kumar","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cmpb.2018.12.027","article-title":"Prediction of sepsis patients using machine learning approach: A meta-analysis","volume":"170","author":"Islam","year":"2019","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/978-1-4615-0205-0_18","article-title":"Modifications of red blood cell shape and glycoproteins membrane content in septic patients","volume":"510","author":"Piagnerelli","year":"2003","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_8","first-page":"19","article-title":"Oxidative stress in sepsis. Possible production of free radicals through an erythrocyte-mediated positive feedback mechanism","volume":"21","author":"Couto","year":"2017","journal-title":"BJID"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bateman, R.M., Sharpe, M.D., Singer, M., and Ellis, C.G. (2017). The Effect of Sepsis on the Erythrocyte. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18091932"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/0736-4679(91)90592-4","article-title":"The red blood cell distribution width","volume":"9","author":"Evans","year":"1991","journal-title":"J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.ajem.2012.10.017","article-title":"Red cell distribution width is a prognostic factor in severe sepsis and septic shock","volume":"31","author":"Jo","year":"2013","journal-title":"Am. J. Emerg Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1177\/0885066612452838","article-title":"Red cell distribution width and outcome in patients with septic shock","volume":"28","author":"Sadaka","year":"2013","journal-title":"J. Intensive Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3233\/CH-160154","article-title":"No relationship between red blood cell distribution width and microcirculatory alterations in septic patients","volume":"66","author":"Fontana","year":"2017","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3041","DOI":"10.1097\/CCM.0b013e3181b02b3f","article-title":"Early alterations of red blood cell rheology in critically ill patients","volume":"37","author":"Reggiori","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_15","first-page":"1","article-title":"Anemia of critical illness\u2014A narrative review","volume":"54","author":"Czempik","year":"2022","journal-title":"Acta Haematol. Pol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"566","DOI":"10.5603\/AHP.2021.0091","article-title":"Ferritin and transferrin saturation cannot be used for diagnosis of iron-deficiency anaemia in critically ill patients","volume":"52","author":"Czempik","year":"2021","journal-title":"Acta Haematol. Pol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1111\/jth.14578","article-title":"Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation","volume":"17","author":"Iba","year":"2019","journal-title":"J. Thromb. Haemost."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1172\/JCI28111","article-title":"Oxidative stress in sepsis: A redox redux","volume":"17","author":"Kolls","year":"2006","journal-title":"J. Clin. Investig."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1191\/0267659105pf793oa","article-title":"Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device","volume":"20","author":"Pierce","year":"2005","journal-title":"Perfusion"},{"key":"ref_20","first-page":"e12912","article-title":"Red Cell Distribution Width as a Predictor of Mortality in Patients with Sepsis","volume":"13","author":"Krishna","year":"2021","journal-title":"Cureus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1536\/ihj.50.301","article-title":"Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease","volume":"50","author":"Fukuta","year":"2009","journal-title":"Int. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"R282","DOI":"10.1186\/cc13145","article-title":"An increase in red blood cell distribution width from baseline predicts mortality in patients with severe sepsis or septic shock","volume":"17","author":"Kim","year":"2013","journal-title":"Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1001\/archinternmed.2009.55","article-title":"Red blood cell distribution width and mortality risk in a community-based prospective cohort","volume":"169","author":"Perlstein","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jns.2008.10.024","article-title":"Elevated red blood cell distribution width predicts mortality in persons with known stroke","volume":"277","author":"Ani","year":"2009","journal-title":"J. Neurol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.amjcard.2010.12.023","article-title":"Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease","volume":"107","author":"Ye","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.ijcard.2008.11.187","article-title":"Relation between red blood cell distribution width (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography","volume":"141","author":"Cavusoglu","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1001\/archinternmed.2009.11","article-title":"Red blood cell distribution width and the risk of death in middle-aged and older adults","volume":"169","author":"Patel","year":"2009","journal-title":"Arch. Intern. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"40","DOI":"10.3109\/07853890.2010.521766","article-title":"Red cell distribution width as a novel predictor of mortality in ICU patients","volume":"43","author":"Wang","year":"2011","journal-title":"Ann. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1097\/CCM.0b013e31821b85c6","article-title":"Red cell distribution width and all-cause mortality in critically ill patients","volume":"39","author":"Bazick","year":"2011","journal-title":"Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/PEC.0000000000001319","article-title":"A Study of Red Cell Distribution Width in Neonatal Sepsis","volume":"36","author":"Ellahony","year":"2020","journal-title":"Pediatric Emerg. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"278","DOI":"10.4103\/2229-5151.147518","article-title":"Broadening of the red blood cell distribution width is associated with increased severity of illness in patients with sepsis","volume":"4","author":"Mahmood","year":"2014","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1161\/CIRCULATIONAHA.107.727545","article-title":"Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease","volume":"117","author":"Tonelli","year":"2008","journal-title":"Circulation"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.amjcard.2009.05.016","article-title":"Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension","volume":"104","author":"Hampole","year":"2009","journal-title":"Am. J. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1186\/s13054-021-03860-7","article-title":"Albumin and fibrinogen kinetics in sepsis: A prospective observational study","volume":"25","author":"Omiya","year":"2021","journal-title":"Crit. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.thromres.2019.07.002","article-title":"Significance of plasma fibrinogen level and antithrombin activity in sepsis: A multicenter cohort study using a cubic spline model","volume":"181","author":"Matsubara","year":"2019","journal-title":"Thromb. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.cca.2014.11.012","article-title":"Sepsis biomarkers","volume":"440","author":"Prucha","year":"2015","journal-title":"Clin. Chim. Acta"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"020709","DOI":"10.11613\/BM.2021.020709","article-title":"Performance of D-dimer for predicting sepsis mortality in the intensive care unit","volume":"31","author":"Han","year":"2021","journal-title":"Biochem. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1097\/CCM.0000000000002997","article-title":"Sepsis-Associated Coagulopathy Severity Predicts Hospital Mortality","volume":"46","author":"Lyons","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1111\/jth.15246","article-title":"Consumptive coagulopathy is associated with a disturbed host response in patients with sepsis","volume":"19","author":"Uhel","year":"2021","journal-title":"J. Thromb. Haemost."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/01.CCM.0000110678.52863.F3","article-title":"Utility of activated partial thromboplastin time waveform analysis for identification of sepsis and overt disseminated intravascular coagulation in patients admitted to a surgical intensive care unit","volume":"32","author":"Dempfle","year":"2004","journal-title":"Crit. Care Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1097\/01.CCM.0000217471.12799.1C","article-title":"Activated partial thromboplastin time waveform analysis: A new tool to detect infection?","volume":"34","author":"Chopin","year":"2006","journal-title":"Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e23151","DOI":"10.1097\/MD.0000000000023151","article-title":"Platelets as a prognostic marker for sepsis: A cohort study from the MIMIC-III database","volume":"99","author":"Zhao","year":"2020","journal-title":"Medicine"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/11\/6626\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:20:50Z","timestamp":1760138450000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/11\/6626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,29]]},"references-count":43,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["ijerph19116626"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19116626","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,29]]}}}