Marcel Levi

Coagulation abnormalities are a fundamental component of sepsis pathophysiology and contribute directly to organ dysfunction and mortality. The sepsis-induced coagulopathy (SIC) criteria, introduced in 2017 by the International Society on Thrombosis and Haemostasis (ISTH), represented a major advance by providing a practical framework for identifying early sepsis-associated coagulopathy and predicting progression to overt disseminated intravascular coagulation (DIC). However, after nearly a decade of clinical experience, several limitations have become apparent. In particular, incorporation of the Sequential Organ Failure Assessment (SOFA) score complicates bedside application and blurs the distinction between coagulation-specific abnormalities and global illness severity. The newly proposed SIC-2 removes the SOFA component and relies exclusively on platelet count and prothrombin time–international normalized ratio (PT-INR), thereby preserving conceptual clarity and improving feasibility. Emerging evidence suggests that SIC-2 maintains the ability to identify patients at risk of developing DIC while simplifying serial monitoring. Although an effective anticoagulant therapy for sepsis has not yet been established, serial assessment of coagulation trajectories may facilitate risk stratification. Whether changes in SIC-2 can identify patients likely to benefit from anticoagulant therapy or determine the optimal timing of treatment remains an important hypothesis that requires prospective validation. This perspective discusses the evolution from the original SIC criteria to SIC-2 and considers the future role of coagulation monitoring in sepsis-associated DIC.

Over the past few decades, healthcare has made remarkable advances. Across nearly all fields, diseases are better understood, and diagnostic and therapeutic options have expanded dramatically. Laboratory medicine is also developing at a rapid pace and is playing an increasingly central role in the diagnostic process, as well as in the monitoring of therapy and disease progression. For many conditions—including cardiovascular disease and cancer—patient outcomes have improved spectacularly. However, this success has also created new challenges. Death from acute illness has increasingly been replaced by survival with chronic disease. An aging—though not necessarily healthy—population demands substantial personal, financial, and organizational support. Hyperspecialization is poorly suited to meeting these complex needs. Moreover, efficiency‐driven centralization of care, encompassing both clinical services and laboratories, may be necessary but often introduces new problems that can only be addressed through innovation and technology. Most importantly, strong professional leadership is essential. With healthcare professionals in the lead, we can ensure a resilient and sustainable healthcare system, supported by high‐quality laboratory services, in which complex issues such as superspecialization, centralization, and efficiency are addressed in an optimal and integrated manner.