Early D-Dimer-Lactate Risk Categories and ICU Mortality in Patients with Sepsis: A Single-Center Retrospective Cohort Study.
- 1Department of Emergency, Ningbo Medical Center Lihuili Hospital, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, People's Republic of China.
- 2Department of Intensive Care Unit, Ningbo Medical Center Lihuili Hospital, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China.
Abstract
Background
D-dimer and lactate are commonly measured early in sepsis and reflect complementary coagulation and metabolic stress pathways. Whether a simple combined D-dimer-lactate risk stratification is associated with ICU mortality remains clinically relevant.Methods
We conducted a retrospective cohort study of adult patients with sepsis admitted to the ICU. High D-dimer was defined as the cohort upper quartile (Q75 = 2958), and elevated lactate was defined as lactate ≥2 mmol/L. Patients were classified into four categories: neither elevated, D-dimer only, lactate only, and both elevated. Non-core covariates with missing values were handled using multiple imputation. Logistic regression models estimated the association with ICU mortality after adjustment for age, sex, BMI, infection source, five binary comorbidities, and SOFA score.Results
This study included 779 patients with complete D-dimer, lactate, and ICU mortality data. ICU mortality increased across the combined categories: 26/311 (8.4%, 95% CI 5.5-12.0) in neither elevated, 7/74 (9.5%, 95% CI 3.9-18.5) in D-dimer only, 49/273 (17.9%, 95% CI 13.6-23.0) in lactate only, and 49/121 (40.5%, 95% CI 31.7-49.8) in both elevated. In the fully adjusted model, the both-elevated category was associated with higher ICU mortality compared with neither elevated (OR 3.94, 95% CI 2.03-7.67; P<0.001). Lactate-only elevation was also associated with mortality (OR 2.00, 95% CI 1.15-3.48; P=0.015), whereas isolated high D-dimer was not (OR 0.87, 95% CI 0.34-2.24; P=0.771). The four-category scheme alone showed numerically lower discrimination than lactate alone (AUC 0.691 vs 0.740). Adding the categories to the base clinical model increased the AUC from 0.791 to 0.813 (delta AUC 0.022; P=0.029), an exploratory finding that should not be interpreted as proof that the categories improve prediction beyond lactate.Conclusion
Early D-dimer-lactate risk categories were associated with ICU mortality and identified a clinically interpretable high-risk subgroup among ICU patients with sepsis. Their predictive utility beyond lactate and established clinical predictors remains uncertain. These categories should be interpreted as pragmatic risk stratification rather than evidence of a validated biological phenotype or statistical synergy, and external validation is warranted.
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BibTeX
@article{rong2026early,
title = {{Early D-Dimer-Lactate Risk Categories and ICU Mortality in Patients with Sepsis: A Single-Center Retrospective Cohort Study.}},
author = {Jianning Rong and Li Jiang and Jian Guo and Jinzhi Li and Weili Jiang and Chengen Xu and Jianjiang Fang},
journal = {Journal of inflammation research},
year = {2026},
month = oct,
doi = {10.2147/jir.s644343},
url = {https://europepmc.org/article/MED/42974462},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Early D-Dimer-Lactate Risk Categories and ICU Mortality in Patients with Sepsis: A Single-Center Retrospective Cohort Study.
AU - Jianning Rong
AU - Li Jiang
AU - Jian Guo
AU - Jinzhi Li
AU - Weili Jiang
AU - Chengen Xu
AU - Jianjiang Fang
PY - 2026
DA - 2026/10/29
JO - Journal of inflammation research
DO - 10.2147/jir.s644343
UR - https://europepmc.org/article/MED/42974462
AB - Background D-dimer and lactate are commonly measured early in sepsis and reflect complementary coagulation and metabolic stress pathways. Whether a simple combined D-dimer-lactate risk stratification is associated with ICU mortality remains clinically relevant.Methods We conducted a retrospective cohort study of adult patients with sepsis admitted to the ICU. High D-dimer was defined as the cohort upper quartile (Q75 = 2958), and elevated lactate was defined as lactate ≥2 mmol/L. Patients were classified into four categories: neither elevated, D-dimer only, lactate only, and both elevated. Non-core covariates with missing values were handled using multiple imputation. Logistic regression models estimated the association with ICU mortality after adjustment for age, sex, BMI, infection source, five binary comorbidities, and SOFA score.Results This study included 779 patients with complete D-dimer, lactate, and ICU mortality data. ICU mortality increased across the combined categories: 26/311 (8.4%, 95% CI 5.5-12.0) in neither elevated, 7/74 (9.5%, 95% CI 3.9-18.5) in D-dimer only, 49/273 (17.9%, 95% CI 13.6-23.0) in lactate only, and 49/121 (40.5%, 95% CI 31.7-49.8) in both elevated. In the fully adjusted model, the both-elevated category was associated with higher ICU mortality compared with neither elevated (OR 3.94, 95% CI 2.03-7.67; P<0.001). Lactate-only elevation was also associated with mortality (OR 2.00, 95% CI 1.15-3.48; P=0.015), whereas isolated high D-dimer was not (OR 0.87, 95% CI 0.34-2.24; P=0.771). The four-category scheme alone showed numerically lower discrimination than lactate alone (AUC 0.691 vs 0.740). Adding the categories to the base clinical model increased the AUC from 0.791 to 0.813 (delta AUC 0.022; P=0.029), an exploratory finding that should not be interpreted as proof that the categories improve prediction beyond lactate.Conclusion Early D-dimer-lactate risk categories were associated with ICU mortality and identified a clinically interpretable high-risk subgroup among ICU patients with sepsis. Their predictive utility beyond lactate and established clinical predictors remains uncertain. These categories should be interpreted as pragmatic risk stratification rather than evidence of a validated biological phenotype or statistical synergy, and external validation is warranted.
SN - 1178-7031
ER -