Abstract
BACKGROUND: Sepsis, a leading cause of mortality in intensive care units, is associated with coagulation dysfunction, a key pathological feature linked to multi-organ failure. However, the prognostic value of coagulation markers remains heterogeneous across studies. OBJECTIVE: This meta-analysis aimed to evaluate the association between coagulation parameters and clinical outcomes in sepsis patients, focusing on their predictive performance. METHODS: Following PRISMA guidelines, nine studies (n = 1954) were included from PubMed, Embase, Cochrane Library, and Web of Science. The associations of coagulation markers (APTT, PT, D-dimer, fibrinogen, INR) and SOFA scores with the outcome were quantified using pooled odds ratios (ORs) with 95% confidence intervals. Diagnostic accuracy was summarized by the area under the curve (AUC). Heterogeneity was assessed using the I (2) statistic, and a random-effects model was employed to account for between-study variation. The robustness of the findings was evaluated through sensitivity analyses. RESULTS: Fibrinogen showed a significant inverse correlation with mortality [OR = 0.76, 95% CI (0.59-0.97)], while INR demonstrated moderate predictive ability (AUC = 0.68). APTT and PT had non-significant ORs but moderate AUCs (0.75 and 0.75, respectively). D-dimer and SOFA score ORs were non-significant, though SOFA's AUC indicated good prognostic utility. High heterogeneity (I (2) > 74%) and sensitivity to individual studies were noted. CONCLUSION: Specific coagulation markers, notably fibrinogen and INR, may aid in sepsis prognosis assessment, but variability across studies limits generalizability. Further high-quality studies are warranted to validate these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251049209, identifier CRD420251049209.