title: Assessment of Haemostasis in Disseminated Intravascular Coagulation by Use of Point-of-Care Assays and Routine Coagulation Tests, in Critically Ill Patients; A Prospective Observational Study.
abstract: BACKGROUND
  Disseminated intravascular coagulopathy (DIC) relates to the consumption of coagulation factors and platelets with bleeding and micro thrombosis events.
  
  
  OBJECTIVE
  The aim of this study was to compare haemostasis parameters in critically ill patients with DIC versus patients without DIC, and in survivors versus non-survivors over time. Correlations between the DIC-score, the degree of organ failure and the haemostasis were assessed.
  
  
  METHODS
  Patients admitted to the intensive care unit with a condition known to be associated with DIC and with an expected length of stay of >3 days were included. Routine laboratory tests, prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen concentration and D-dimer were measured. Coagulation and platelet function were assessed with two point-of-care devices; Multiplate and ROTEM. DIC scores were calculated according to the International Society on Thrombosis and Haemostasis and Japanese Association for Acute Medicine.
  
  
  RESULTS
  Blood was sampled on days 0-1, 2-3 and 4-10 from 136 patients with mixed diagnoses during 290 sampling events. The point-of-care assays indicated a hypocoagulative response (decreased platelet aggregation and reduced clot strength) in patients with DIC and, over time, in non-survivors compared to survivors. Patients with DIC as well as non-survivors had decreased fibrinolysis as shown by ROTEM. DIC scores were higher in non-survivors than in survivors.
  
  
  CONCLUSIONS
  Patients with DIC displayed signs of a hypocoagulative response and impaired fibrinolysis, which was also evident over time in non-survivors. Patients with DIC had a higher mortality rate than non-DIC patients, and DIC scores were higher in non-survivors than in survivors.
authors.affiliation: Medical Faculty, University of Lund, Lund, Sweden.|Department of Intensive and Perioperative Care, Skåne University Hospital Lund, 22185, Lund, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kander
authors.affiliation: Medical Faculty, University of Lund, Lund, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Larsson
authors.affiliation: Medical Faculty, University of Lund, Lund, Sweden.
authors.forename: Victor
authors.initials: V
authors.lastname: Taune
authors.affiliation: Medical Faculty, University of Lund, Lund, Sweden.|Department of Intensive and Perioperative Care, Skåne University Hospital Lund, 22185, Lund, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Schött
authors.affiliation: Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.|Department of Clinical Chemistry and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Nahreen
authors.initials: N
authors.lastname: Tynngård
mesh_terms: D000368:Aged; D016638:Critical Illness; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000502:physiology; D019095:Point-of-Care Systems; D011446:Prospective Studies