Evaluation of modified non-overt DIC criteria on the prediction of poor outcome in patients with sepsis.
BACKGROUND
The diagnostic performance of modified criteria for non-overt disseminated intravascular coagulation (DIC) with the addition of antithrombin (AT) levels, protein C (PC) levels, and organ system failure scoring (OSF) to the International Society on Thrombosis and Hemostasis (ISTH) criteria for non-overt DIC was studied to determine the effect on predicting poor outcome in patients with sepsis.


METHODS
In total, 135 consecutive patients were studied. Hemostatic markers (platelet count, prothrombin time, D-dimer, AT, PC) were examined on days 0, 1, 2, 3, 4, and 7. ISTH overt and non-overt DIC scoring, OSF, and 28-day mortality were analyzed.


RESULTS
The numbers of patients with overt DIC, non-overt DIC and non-DIC were 42, 17 and 76 respectively. The 28-day mortality rates for ISTH overt DIC, ISTH non-overt DIC, and non-DIC were 47.6, 47.1, and 9.2%, respectively. By adding AT and PC to the ISTH non-overt DIC criteria, the 28-day mortality rate of overt DIC, non-overt DIC, and non-DIC changed to 47.6, 25.0, and 6.7%, respectively. By adding OSF to the ISTH non-overt DIC criteria to predict 28-day mortality in septic patients, receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) of ISTH non-overt DIC (0.777) was significantly increased to 0.878 (P=0.018). However, neither AT nor PC increased the AUC.


CONCLUSIONS
Addition of OSF to the ISTH criteria for non-overt DIC gives a better prediction of poor outcome in patients with sepsis.
Oh
D
D
Department of Internal Medicine, College of Medicine, Pochon CHA University, Sungnam, Korea. doh@cha.ac.kr
Jang
M J
MJ
Lee
S J
SJ
Chong
S Y
SY
Kang
M S
MS
Wada
H
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III; D000991:Antithrombins; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D011486:Protein C; D011517:Prothrombin Time; D012372:ROC Curve; D018805:Sepsis / Q000401:mortality; D013927:Thrombosis; D016896:Treatment Outcome
D000991:Antithrombins; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C036309:fibrin fragment D; D000990:Antithrombin III