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


METHODS
Prospective, multicenter study during a 4-month period.


METHODS
General critical care center in a tertiary care hospital.


METHODS
All patients were enrolled when they were diagnosed as DIC by the JAAM DIC scoring system.


METHODS
None.


RESULTS
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.


CONCLUSIONS
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.
Gando
Satoshi
S
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. gando@med.hokudai.ac.jp
Saitoh
Daizoh
D
Ogura
Hiroshi
H
Mayumi
Toshihiko
T
Koseki
Kazuhide
K
Ikeda
Toshiaki
T
Ishikura
Hiroyasu
H
Iba
Toshiaki
T
Ueyama
Masashi
M
Eguchi
Yutaka
Y
Ohtomo
Yasuhiro
Y
Okamoto
Kohji
K
Kushimoto
Shigeki
S
Endo
Shigeatsu
S
Shimazaki
Shuji
S
D015415:Biomarkers / Q000378:metabolism; D015897:Comorbidity; D016638:Critical Illness; D018450:Disease Progression; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000453:epidemiology* / Q000378:metabolism; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
D015415:Biomarkers