title: Evaluation of early detection and management of disseminated intravascular coagulation among Alexandria University pediatric intensive care patients.
abstract: This prospective study over 24 months aimed to evaluate the outcome of early management of disseminated intravascular coagulation (DIC) among high-risk patients (n = 50) admitted to a pediatric intensive care unit (PICU). It also included all cases presenting with overt DIC (OD) concomitantly (n = 30). The high-risk group (pre-DIC) was subdivided, according to their D-dimer assay, into negative (n = 14) and positive (n = 36) D-dimer groups. All three groups were evaluated, on admission, for their prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen level (Fi), fibrinogen degradation products (FDP), platelet count, and presence/absence of schistocytes in peripheral blood. The combination of D-dimer and FDP assay showed the best correlation for early pre-DIC diagnosis (r = 0.9048). FDP assay was the best parameter for followup of progress of DIC condition in the PICU. The lowest mortality was among negative D-dimer, followed by positive D-dimer and OD groups (28.6 per cent, 77.8 per cent, and 93.3 per cent, respectively). Among the positive D-dimer group the lowest mortality was encountered in the subgroup treated with plasma, heparin and tranexamic acid (33 per cent) while those treated with non-specific therapy, plasma only, or plasma and heparin showed higher mortality (100 per cent, 80 per cent, and 100 per cent, respectively). The deceased subgroup, among positive D-dimer cases showed a significantly higher number of patients presenting with multiple organ failure on admission compared with the discharged group. In summary, early diagnosis and proper management of pre-DIC, before overt bleeding, in high-risk patients admitted to a PICU using combined D-dimer and FDP assays had a positive impact on their prognosis.
authors.affiliation: Pediatrics Department, Faculty of Medicine, Alexandria University, Egypt. dr_anawawy@yahoo.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Nawawy
authors.forename: Ahmed Amr
authors.initials: AA
authors.lastname: Abbassy
authors.forename: Magdy
authors.initials: M
authors.lastname: El-Bordiny
authors.forename: Sama'a
authors.initials: S
authors.lastname: Essawi
mesh_terms: D001780:Blood Coagulation Tests; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003906:Developing Countries; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D042241:Early Diagnosis; D004534:Egypt; D005069:Evaluation Studies as Topic; D005260:Female; D005440:Fluid Therapy; D006493:Heparin / Q000627:therapeutic use; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D010314:Partial Thromboplastin Time; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006493:Heparin