Prognostic gene landscapes and therapeutic insights in sepsis-induced coagulopathy

Background: Sepsis is a common and critical condition encountered in clinical practice that can lead to multi-organ dysfunction. Sepsis-induced coagulopathy (SIC) significantly affects patient outcomes. However, the precise mechanisms remain unclear, making the identification of effective prognostic and therapeutic targets imperative.

Methods: The analysis of transcriptome data from the whole blood of sepsis patients, facilitated the identification of key genes implicated in coagulation. Then we developed a prognostic model and a nomogram to predict patient survival. Consensus clustering classified sepsis patients into three subgroups for comparative analysis of immune function and immune cell infiltration. Single-cell Sequencing elucidated alterations in intercellular communication between platelets and immune cells in sepsis, as well as the role of the coagulation-related gene Fyn. Real-time quantitative PCR determined the mRNA levels of critical coagulation genes in septic rats' blood. Finally, administration of a Fyn agonist to septic rats was observed for its effects on coagulation functions and survival.

Results: This study identified four pivotal genes-CFD, Fyn, ITGAM, and VSIG4-as significant predictors of survival in patients with sepsis. Among them, CFD, Fyn, and ITGAM were underexpressed, while VSIG4 was upregulated in patients with sepsis. Moreover, a nomogram that incorporates the coagulation-related genes (CoRGs) risk score with clinical features of patients accurately predicted survival probabilities. Subgroup analysis of CoRGs expression delineated three molecular sepsis subtypes, each with distinct prognoses and immune profiles. Single-cell Sequencing shed light on heightened communication between platelets and monocytes, T cells, and plasmacytoid dendritic cells, alongside reduced interactions with neutrophils in sepsis. The Collagen signaling pathway was found to be essential in this dynamic. Fyn may affect platelet function by modulating factors such as ELF1, PTCRA, and RASGRP2. The administration of the Fyn agonist can effectively improve coagulation dysfunction and survival in septic rats.

Conclusions: The research identifies CoRGs as crucial prognostic markers for sepsis, highlighting the Fyn gene's central role in coagulation disorders associated with the condition and suggesting novel therapeutic intervention strategies.

Immune cell infiltration; Nomogram; Platelet activation; Prognosis; Sepsis-induced coagulopathy.