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Day 3 versus Day 1 disseminated intravascular coagulation score among sepsis patients: a prospective observational
1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Seoul, Korea.
Insights
The change in disseminated intravascular coagulation (DIC) scores, not static scores, significantly predicts hospital mortality in sepsis patients. Pneumonia sepsis cases showed lower early DIC incidence but higher mortality.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- Disseminated intravascular coagulation (DIC) is a critical complication in sepsis, but its role and predictive value require further investigation.
- Limited studies have extensively explored the incidence and prognostic significance of DIC in sepsis patients.
Purpose of the Study:
- To investigate the incidence of overt DIC in sepsis patients at early (day 1) and intermediate (day 3) time points.
- To evaluate the association between DIC scores, changes in DIC scores, and hospital mortality in sepsis.
- To compare the predictive accuracy of DIC scores in sepsis patients with and without pneumonia.
Main Methods:
- A prospective study enrolled 219 sepsis patients diagnosed using International Society of Thrombosis and Haemostasis criteria for DIC.
- Incidences of overt DIC were assessed at day 1 and day 3 post-sepsis diagnosis.
- Multivariate logistic regression was used to analyze the association between DIC scores and hospital mortality, adjusting for existing severity scores.
Main Results:
- Overt DIC was observed in 27.9% of patients on day 1 and 30.1% on day 3.
- While day 1 and day 3 DIC scores were not independently associated with mortality, the change in DIC scores showed a significant association (OR 1.862).
- Day 3 DIC scores were more accurate predictors of mortality than day 1 scores, particularly in non-pneumonia sepsis. Pneumonia sepsis patients had lower day 1 DIC incidence but higher mortality.
Conclusions:
- The dynamic change in DIC scores, rather than static scores, is significantly associated with hospital mortality in sepsis.
- DIC scoring systems did not add significant discriminative power to existing prognostic scores for sepsis mortality.
- Pneumonia-associated sepsis presents with a lower incidence of early DIC despite higher severity and mortality, suggesting complex pathophysiological differences.
Abstract:
The role of disseminated intravascular coagulation (DIC) has not been extensively studied in patients with sepsis. A prospective study was performed in a single university hospital. The incidences of DIC at day 1 (<24 hours post-sepsis diagnosis) and day 3 (48 to 72 hours) were investigated among patients with sepsis. The International Society of Thrombosis and Haemostasis criteria for DIC were used. Among 381 patients initially screened, 219 were enrolled in this study and the incidences of overt DIC were 27.9% and 30.1% on day 1 and day 3, respectively. Patients with pneumonia had a lower incidence of DIC on day 1, but a higher hospital mortality rate compared to those with non-pneumonia sepsis. In multivariate models, although day 1 and day 3 DIC scores were not associated with hospital mortality after adjusting for existing severity scores, the change in DIC scores (odds ratio 1.862; 95% confidence interval 1.061 to 3.266) exhibited a significant association. Day 3 DIC scores were more accurate in predicting hospital mortality than day 1 DIC scores (P <0.001), especially in patients with non-pneumonia sepsis. However, DIC scores did not give additional discriminative power to the existing prognostic scores in predicting mortality of patients with sepsis. In conclusion, the change in DIC score was significantly associated with hospital mortality. Patients with pneumonia sepsis had a lower incidence of DIC on day 1, despite their higher disease severity and mortality rate, compared to those with other sources of sepsis.
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