Association between antithrombin levels and prognosis in patients with sepsis: a retrospective cohort study based on the MIMIC-IV and MIMIC-III databases

doi:10.1186/s40560-026-00862-x

Sepsis & infection

Association between antithrombin levels and prognosis in patients with sepsis: a retrospective cohort study based on the MIMIC-IV and MIMIC-III databases

J Intensive CarePublished 2 Feb 2026Retrospective cohort study

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Authors' conclusion

Reduced AT activity was significantly associated with higher mortality and organ dysfunction in sepsis. Risk thresholds were observed at approximately 55% for the overall cohort and 64% among hypertensive patients. Patients below these levels exhibited significantly increased mortality and higher incidences of DIC and AKI.

Study context

Population: Septic patients from the MIMIC-IV and MIMIC-III databases
Participants: 222 patients

Exposure: Antithrombin (AT) activity < 55% vs ≥ 55%
Outcome: All-cause mortality
Follow-up: 28 days

Methodological detailsMIMIC-IV and MIMIC-III databases, restricted cubic splines, multivariable Cox regression

MIMIC-IV and MIMIC-III databases
Restricted cubic splines
Multivariable Cox regression

Main finding

As reported in the abstract

28-day mortality

AT < 55%34.2%

AT ≥ 55%14.4%

P = 0.001

Observational data: associations, not effects.

Further findings

ICU mortality

P < 0.001

AT < 55%33.3%

AT ≥ 55%9.0%

DIC incidence

P < 0.001

AT < 55%22.5%

AT ≥ 55%3.6%

AKI incidence

P = 0.013

AT < 55%78.4%

AT ≥ 55%62.2%

Outcome	P value
28-day mortality (hypertensive subgroup, AT < 64% vs ≥ 64%)	P < 0.001
ICU mortality (hypertensive subgroup)AT < 64% vs AT ≥ 64%	P < 0.001
DIC incidence (hypertensive subgroup)AT < 64% vs AT ≥ 64%	P < 0.001

28-day mortality (hypertensive subgroup, AT < 64% vs ≥ 64%): AT < 64% 42.3%
28-day mortality (hypertensive subgroup, AT < 64% vs ≥ 64%): AT ≥ 64% 9.62%
ICU mortality (hypertensive subgroup): AT < 64% 38.5%
ICU mortality (hypertensive subgroup): AT ≥ 64% 5.77%
Disseminated intravascular coagulation (DIC) incidence (hypertensive subgroup): AT < 64% 19.2%
DIC incidence (hypertensive subgroup): AT ≥ 64% 1.92%

28-day mortality (hypertensive subgroup, AT < 64% vs ≥ 64%)

Significant interaction with hypertension; elevated risk zone below ≈64% AT activity

Original publication

Association between antithrombin levels and prognosis in patients with sepsis: a retrospective cohort study based on the MIMIC-IV and MIMIC-III databases. J Intensive Care. Published 2 February 2026. doi:10.1186/s40560-026-00862-x

Read the original article ↗

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