Prediction of survival in patients suspected of disseminated intravascular coagulation.
BACKGROUND
Although antithrombin (AT), protein C (PC), and antiplasmin (AP) are consumed during disseminated intravascular coagulation (DIC), their association with mortality in patients initially suspected of acute DIC is unknown. We examined how these proteins associate with mortality in consecutive patients initially suspected of DIC, fulfilling or not fulfilling overt DIC criteria.


METHODS
All consecutive patients clinically suspected of acute DIC during 5 years at a tertiary referral hospital were scored according to overt International Society of Thrombosis and Haemostasis (ISTH) DIC criteria. The influence of ISTH DIC score and measurements of AT, PC, and AP measured in all on mortality was assessed.


RESULTS
During 1825 occurrences in 1814 patients, 91 fulfilled ISTH criteria for overt DIC (score ≥ 5). Both 28-day and 1-year mortality increased progressively as AT and in particular PC decreased. AT and PC correlated inversely with ISTH score (AT: R(2 ) = 0.14, P < 0.001, PC: R(2 ) = 0.21, P < 0.001). AP decreased when ISTH score of > 3 was reached. The 28-day mortality was 3%, 11%, 16%, 23%, 35%, and 52% and 1-year mortality 5%, 18%, 24%, 36%, 54%, and 63%, respectively for patients with an ISTH score of 0, 1, 2, 3, 4, and ≥5 (P < 0.001 for all).


CONCLUSIONS
Lowered AT and in particular PC activity was predictive of mortality risk upfront in critically ill patients suspected of acute DIC. Mortality in patients suspected of acute DIC increased progressively across the spectrum of the overt ISTH score and not only in those fulfilling overt DIC criteria.
University of Iceland School of Health Sciences, Landspitali National University Hospital, Reykjavik, Iceland.
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Hjorleifsson
Department of Anaesthesiology and Intensive Care Medicine, Landspitali National University Hospital, Reykjavik, Iceland.|Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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Sigurdsson
Central Laboratory, Division of Laboratory Hematology and Coagulation Disorders, Landspitali National University Hospital, Reykjavik, Iceland.
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Gudmundsdottir
University of Iceland School of Health Sciences, Landspitali National University Hospital, Reykjavik, Iceland.|Department of Anaesthesiology and Intensive Care Medicine, Landspitali National University Hospital, Reykjavik, Iceland.
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Sigurdsson
University of Iceland School of Health Sciences, Landspitali National University Hospital, Reykjavik, Iceland.|Central Laboratory, Division of Laboratory Hematology and Coagulation Disorders, Landspitali National University Hospital, Reykjavik, Iceland.
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Onundarson
D000328:Adult; D015331:Cohort Studies; D004211:Disseminated Intravascular Coagulation / Q000401:mortality*; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D012720:Severity of Illness Index; D016019:Survival Analysis