title: Prognosis of overt disseminated intravascular coagulation in patients admitted to a medical emergency department.
abstract: OBJECTIVE
  To assess the prevalence, characteristics and prognosis of overt disseminated intravascular coagulation (DIC) in adult emergency department (ED) patients and identify markers of poor outcome.
  
  
  METHODS
  In a chart review study, we analysed the occurrence of overt DIC in all patients (n=1 001 727) attending the University's ED from 2003 to 2014 applying the ISTH DIC score. The primary outcome measure was 30-day mortality. Logistic regression analysis was used to determine predictors of mortality.
  
  
  RESULTS
  The initial inter-rater reliability in the diagnosis of DIC was 0.85 [κ; 95% confidence interval (CI), 0.77-0.92]. The main DIC precipitators were malignancy (47%), cardiovascular diseases (CVD, 27%) and sepsis (16%). Hyperfibrinolytic DIC occurred in 27% of patients and was over-represented in those with cardiac arrest (68%). Thirty-day mortality (52%) was inversely associated with fibrinogen levels on admission [adjusted odds ratio, 0.49; 95% CI: 0.30-0.82; P=0.006]. Afibrinogenaemia implied an even 10-fold increased risk of dying (crude odds ratio, 10.0; 95% CI: 3.2-31.4; P<0.001). D-dimer and platelet count had no predictive value. Appropriate ICD-10 coding for DIC was present in only 1.8% of cases.
  
  
  CONCLUSIONS
  Overt DIC is a rare but underdiagnosed event in ED patients. In this collective, cardiac arrest is a dominant cause of DIC presenting with a fibrinolytic phenotype. The degree of hypofibrinogenaemia on admission strongly and linearly predicted early death.
authors.affiliation: Departments of aClinical Pharmacology bEmergency Medicine cInternal Medicine I, Division of Haematology and Haemostaseology dDepartment of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Schwameis
authors.forename: Nina
authors.initials: N
authors.lastname: Buchtele
authors.forename: Andreas
authors.initials: A
authors.lastname: Schober
authors.forename: Christian
authors.initials: C
authors.lastname: Schoergenhofer
authors.forename: Peter
authors.initials: P
authors.lastname: Quehenberger
authors.forename: Bernd
authors.initials: B
authors.lastname: Jilma
mesh_terms: D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome