Article

Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: Results of a multicenter, prospective survey

Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N17 W5, Kita-ku, Sapporo 060-8638 Japan.
Critical care medicine (Impact Factor: 6.31). 01/2008; 36(1):145-50. DOI: 10.1097/01.CCM.0000295317.97245.2D
Source: PubMed

ABSTRACT

To survey the natural history of disseminated intravascular coagulation (DIC) in patients diagnosed according to the Japanese Association for Acute Medicine (JAAM) DIC scoring system in a critical care setting.
Prospective, multicenter study during a 4-month period.
General critical care center in a tertiary care hospital.
All patients were enrolled when they were diagnosed as DIC by the JAAM DIC scoring system.
None.
Platelet counts, prothrombin time ratio, fibrinogen, and fibrin/fibrinogen degradation products were measured, and the systemic inflammatory response syndrome criteria met by the patients were determined following admission. Of 3,864 patients, 329 (8.5%) were diagnosed with DIC and the 28-day mortality rate was 21.9%, which was significantly different from that of the non-DIC patients (11.2%) (p < .0001). The progression of systemic inflammation, deterioration of organ function, and stepwise increase in incidence of the International Society on Thrombosis and Haemostasis (ISTH) DIC and its scores all correlated with an increase in the JAAM DIC score as demonstrated by the patients on day 0. There were significant differences in the JAAM DIC score and the variables adopted in the scoring system between survivors and nonsurvivors. The logistic regression analyses showed the JAAM DIC score and prothrombin time ratio on the day of DIC diagnosis to be predictors of patient outcome. The patients who simultaneously met the ISTH DIC criteria demonstrated twice the incidence of multiple organ dysfunction (61.1 vs. 30.5%, p < .0001) and mortality rate (34.4 vs. 17.2%, p = .0015) compared with those without the ISTH DIC diagnosis.
This prospective survey demonstrated the natural history of DIC patients diagnosed by the JAAM DIC diagnostic criteria in a critical care setting. The study provides further evidence of a progression from the JAAM DIC to the ISTH overt DIC.

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    • "Massive bleeding (requiring transfusion) was defined as the total amount of packed red blood cells (PRBCs) and FFP ≥2,000 ml (approximately 50% of the circulating blood volume of an average Japanese individual) transfused for 24 hours from the time of initial presentation to the emergency department. DIC diagnosis was made based on the Japanese Association for Acute Medicine (JAAM) DIC diagnosis criteria [14]. The overt DIC score, determined according to the International Society on Thrombosis and Haemostasis (ISTH), was also calculated [15]. "
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    • "These results demonstrate that XBJ injection may obviously alleviate the disease severity in severe septic patients with DIC. Previous studies have shown that incidence of DIC increases with the severity of sepsis [28, 29]. Therefore, these results may be associated with the effects of XBJ injection on DIC. "
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    • "Based on the results of a subgroup analysis of our previous prospective study, we anticipated that the mortality rate of the present study would be 22 to 44% in the antithrombin arm and the control arm, respectively [24,30]. Indeed, the probability of death based on the APACHE II score of the two groups (Table 3) was approximately 30 to 40% [21]. "
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