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Disseminated intravascular coagulation score is associated with mortality for children with shock
Robinder G Khemani1, Robert D Bart, Todd A Alonzo
1Department of Anesthesia and Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mail stop 12, Los Angeles, CA, USA. rkhemani@chla.usc.edu
Insights
The disseminated intravascular coagulation (DIC) score is a strong predictor of mortality in children with sepsis and shock. Early calculation of the DIC score in the pediatric intensive care unit can help identify high-risk patients.
Area of Science:
- Pediatric Critical Care Medicine
- Hematology
- Pediatric Sepsis Research
Background:
- Sepsis and shock are leading causes of mortality in children.
- Disseminated intravascular coagulation (DIC) is a common complication in critically ill children.
- Predictive markers for mortality in pediatric sepsis and shock are crucial for timely intervention.
Purpose of the Study:
- To investigate the association between the Disseminated Intravascular Coagulation (DIC) score and mortality in pediatric patients with shock.
- To determine if the DIC score can serve as an early predictor of outcomes in critically ill children.
Main Methods:
- Retrospective study of 132 children admitted to a pediatric intensive care unit (PICU) between January 2003 and December 2005.
- Analysis included patients diagnosed with sepsis or shock.
- Key variables assessed included peak DIC score within 24 hours of admission, demographic data, and other severity scores.
Main Results:
- A total of 132 patients were analyzed; 42 (31.8%) died.
- Higher DIC scores were significantly associated with increased mortality (50% mortality for DIC score ≥ 5 vs. 20% for DIC score < 5).
- A one-point increase in DIC score correlated with a 1.35-fold increased risk of mortality, independent of initial illness severity.
Conclusions:
- The DIC score is a valuable and easily calculable early predictor of mortality in children with sepsis and shock.
- DIC score provides prognostic information irrespective of initial disease severity or inotropic support.
- Implementing early DIC score assessment in PICUs can aid in risk stratification and management of pediatric shock.
Objective:
To evaluate the association between disseminated intravascular coagulation (DIC) score and mortality for children with shock.
Design:
Retrospective.
Setting:
Tertiary care, 20-bed pediatric intensive care unit.
Patients:
A total of 132 children with sepsis or shock admitted from January 2003 to December 2005.
Measurements And Results:
A total of 132 patients less than 18 years of age with a diagnosis of shock or sepsis were included in the analysis. Of these patients, 90 survived and 42 died (31.8%). Patients ranged from 6 days to 18 years (median 5.8 years), and were a majority male (63%). Variables associated with mortality included peak DIC score within 24 h of ICU admission, age, weight, volume of blood products transfused, inotrope score, pediatric index of mortality (PIM 2) score, 12-h pediatric risk of mortality (PRISM III) score and presence of mechanical ventilation (P < 0.05). Patients with DIC scores >or= 5 (overt DIC) had 50% mortality, compared to 20% for patients with DIC scores < 5. Overall, a one-point rise in DIC score was associated with an increased risk of mortality after adjusting for age, race, gender, hemodynamic instability, and PRISM III score [OR 1.35 (1.02, 1.78)]. Most patients achieve their peak DIC score within 2 h of ICU admission.
Conclusions:
This analysis suggests that DIC score, easily calculated early in ICU admission, is associated with mortality for children with sepsis and shock, regardless of initial severity of illness or inotrope use.
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