BACKGROUND: Endothelium injury and coagulation dysfunction play an important 
role in the pathogenesis of sepsis. Soluble thrombomodulin (sTM), tissue 
plasminogen activator-inhibitor complex (t-PAIC), thrombin-antithrombin complex 
(TAT) and α2-plasmin inhibitor-plasmin complex (PIC) are biomarkers of 
endothelium injury and coagulation dysfunction. This study aimed to explore the 
prognostic values and diagnostic performance for septic shock and sepsis-induced 
disseminated intravascular coagulation (DIC) of endothelial biomarkers.
METHODS: We conducted an observational study on patients with sepsis admitted to 
intensive care unit (ICU) at a teaching hospital from January 2016 to December 
2018. Levels of sTM, t-PAIC, TAT and PIC were measured at admission day and day 
5-7 after admission and detected by qualitative chemiluminescence enzyme 
immunoassay performed on HISCL automated analyzers.
RESULTS: A total of 179 septic patients and 125 non-septic ICU controls were 
enrolled. The level of sTM was higher in septic patients compared to ICU 
controls (OR =1.093, 95% CI: 1.045-1.151, P<0.001). Moreover, higher levels of 
sTM and t-PAIC were independent predictors of poor 60-day prognosis for septic 
patients (HR =1.012, 95% CI: 1.003-1.022, P=0.012; HR =1.014, P=0.009). Level of 
sTM was also higher in patients with septic shock as revealed by multivariate 
analysis (OR =1.049, 95% CI: 1.020-1.078, P=0.001), as well as in patients with 
sepsis-induced DIC (OR =1.109, 95% CI: 1.065-1.158, P<0.001). sTM was considered 
as a sensitive biomarker for the early prediction of septic shock and 
sepsis-induced DIC, with AUC up to 0.765 (0.687-0.842) and 0.864 (0.794-0.935) 
of receiver operating characteristic curve.
CONCLUSIONS: Most patients developed coagulopathy which was closely linked to 
endothelial injury in initial phase of sepsis, which was demonstrated by 
abnormalities in endothelial biomarkers and their strong association with poor 
60-day prognosis and development of septic shock and sepsis-induced DIC.