Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria: Comparison between sepsis and trauma

Shigeki Kushimoto, Satoshi Gando, Daizoh Saitoh, Hiroshi Ogura, Toshihiko Mayumi, Kazuhide Koseki, Toshiaki Ikeda, Hiroyasu Ishikura, Toshiaki Iba, Masashi Ueyama, Yutaka Eguchi, Yasuhiro Otomo, Kohji Okamoto, Shigeatsu Endo, Shuji Shimazaki, Yasuhiro Ohtomo

Research output: Contribution to journalArticlepeer-review

40 Citations (Scopus)

Abstract

The Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH). Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n=98) or trauma (n=95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p<0.0001). Within three days of fulfilling the JAAM criteria, sepsis patients had a lower platelet count, higher prothrombin time ratio, higher systemic inflammatory response syndrome score, and higher Sequential Organ Failure Assessment score compared with trauma patients. On day 3, a significantly higher percentage of trauma patients than sepsis patients showed improvement of DIC (64.2% vs. 30.6%, p<0.001). These differences were mainly due to patients with lower JAAM DIC scores. More than 50% of the JAAM DIC patients with sepsis who died within 28 days could not be detected by ISTH DIC criteria during the initial three days. In contrast, most trauma patients who died within 28 days had DIC simultaneously diagnosed by JAAM and ISTH criteria, except for those with brain death. These findings suggest that coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.

Original languageEnglish
Pages (from-to)1099-1105
Number of pages7
JournalThrombosis and Haemostasis
Volume100
Issue number6
DOIs
Publication statusPublished - 2008 Dec
Externally publishedYes

Keywords

  • Criteria
  • Diagnosis
  • Disseminated intravascular coagulation
  • Sepsis
  • Trauma

ASJC Scopus subject areas

  • Hematology

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