Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: Results of a multicenter, prospective survey

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

Research output: Contribution to journalArticlepeer-review

134 Citations (Scopus)

Abstract

OBJECTIVE: To survey the natural history of disseminated intravascular coagulation (DIC) in patients diagnosed according to the Japanese Association for Acute Medicine (JAAM) DIC scoring system in a critical care setting. DESIGN: Prospective, multicenter study during a 4-month period. SETTING: General critical care center in a tertiary care hospital. PATIENTS: All patients were enrolled when they were diagnosed as DIC by the JAAM DIC scoring system. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Platelet counts, prothrombin time ratio, fibrinogen, and fibrin/fibrinogen degradation products were measured, and the systemic inflammatory response syndrome criteria met by the patients were determined following admission. Of 3,864 patients, 329 (8.5%) were diagnosed with DIC and the 28-day mortality rate was 21.9%, which was significantly different from that of the non-DIC patients (11.2%) (p < .0001). The progression of systemic inflammation, deterioration of organ function, and stepwise increase in incidence of the International Society on Thrombosis and Haemostasis (ISTH) DIC and its scores all correlated with an increase in the JAAM DIC score as demonstrated by the patients on day 0. There were significant differences in the JAAM DIC score and the variables adopted in the scoring system between survivors and nonsurvivors. The logistic regression analyses showed the JAAM DIC score and prothrombin time ratio on the day of DIC diagnosis to be predictors of patient outcome. The patients who simultaneously met the ISTH DIC criteria demonstrated twice the incidence of multiple organ dysfunction (61.1 vs. 30.5%, p < .0001) and mortality rate (34.4 vs. 17.2%, p = .0015) compared with those without the ISTH DIC diagnosis. CONCLUSIONS: This prospective survey demonstrated the natural history of DIC patients diagnosed by the JAAM DIC diagnostic criteria in a critical care setting. The study provides further evidence of a progression from the JAAM DIC to the ISTH overt DIC.

Original languageEnglish
Pages (from-to)145-150
Number of pages6
JournalCritical care medicine
Volume36
Issue number1
DOIs
Publication statusPublished - 2008 Jan
Externally publishedYes

Keywords

  • Critical illness
  • Diagnosis
  • Disseminated intravascular coagulation
  • International Society on Thrombosis and Haemostasis
  • Natural history
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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