Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group. Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria. Comparison between sepsis and trauma
Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Tokyo 113-8603, Japan. Thrombosis and Haemostasis
(Impact Factor: 4.98).
12/2008; 100(6):1099-105. DOI: 10.1160/TH08-05-0306
The Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH). Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n = 98) or trauma (n = 95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p < 0.0001). Within three days of fulfilling the JAAM criteria, sepsis patients had a lower platelet count, higher prothrombin time ratio, higher systemic inflammatory response syndrome score, and higher Sequential Organ Failure Assessment score compared with trauma patients. On day 3, a significantly higher percentage of trauma patients than sepsis patients showed improvement of DIC (64.2% vs. 30.6%, p < 0.001). These differences were mainly due to patients with lower JAAM DIC scores. More than 50% of the JAAM DIC patients with sepsis who died within 28 days could not be detected by ISTH DIC criteria during the initial three days. In contrast, most trauma patients who died within 28 days had DIC simultaneously diagnosed by JAAM and ISTH criteria, except for those with brain death. These findings suggest that coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.
Available from: PubMed Central
- "The serum concentration of acute-phase proteins, such as protein C, increases, and the mobilization of the complement cascade system leads to the appearance of C3a and C5a components , which further increase production of proinflammatory cytokines . The coagulation cascade overactivates, leading to disseminated intravascular coagulopathy, which disturbs the hemodynamic equilibrium and finally leads to microvessel thrombosis [82, 83]. Consequently, there is impairment of blood–brain barrier integrity, allowing the influx of other active compounds that stimulate the inflammatory response and spread it through the brain. "
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ABSTRACT: Every year, more cases of sepsis appear in intensive care units. The most frequent complication of sepsis is septic encephalopathy (SE), which is also the essential determinant of mortality. Despite many years of research, it still is not known at which stage of sepsis the first signs of SE appear; however, it is considered the most frequent form of encephalopathy. Patients have dysfunction of cognitive abilities and consciousness, and sometimes even epileptic seizures. Despite intensive treatment, the effects of SE remain for many years and constitute an important social problem. Numerous studies indicate that changes in the brain involve free radicals, nitric oxide, increased synthesis of inflammatory factors, disturbances in cerebral circulation, microthromboses, and ischemia, which cause considerable neuronal destruction in different areas of the brain. To determine at what point during sepsis the first signs of SE appear, different experimental models are needed to detect the aforementioned changes and to select the proper therapy for this syndrome.
Current Neurology and Neuroscience Reports 10/2013; 13(10):383. DOI:10.1007/s11910-013-0383-y · 3.06 Impact Factor
Available from: Kosuke Chris Yamada
- "Disseminated intravascular coagulation (DIC) is classified into 3 types depending on the fibrinolytic stage: fibrinolytic inhibitor DIC in septic shock; fibrinolysis-dominant DIC in hemorrhagic shock; and fibrinolysis hyperpermeability DIC in patients with solid tumors.1 The incidence of fibrinolytic inhibitor DIC in sepsis patients is high, and the outcome is poor.2 "
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Few reports have been made on the therapeutic effects as well as pathological features of an antithrombin preparation in patients diagnosed with septic disseminated intravascular coagulation (DIC) by the diagnostic criteria for acute DIC.
Materials and Methods
A total of 88 sepsis patients who had received inpatient hospital care during the period from January 2000 through December 2008 were divided into two groups, an antithrombin group and a non-antithrombin group, to study the outcomes. Furthermore, the relationship between sepsis-related factors and DIC in 44 patients was studied.
The antithrombin group contained 34 patients, and the non-antithrombin group contained 54 patients. The outcomes were significantly better in the antithrombin group. The levels of protein C were low in DIC patients.
Our results suggest that early administration of antithrombin might improve outcomes of septic DIC patients in the diagnostic criteria for Japanese Association for Acute Medicine acute DIC.
Yonsei medical journal 05/2013; 54(3):686-9. DOI:10.3349/ymj.2013.54.3.686 · 1.29 Impact Factor
Thrombosis and Haemostasis 01/2009; 100(6):958-9. DOI:10.1160/TH08-10-0683 · 4.98 Impact Factor
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