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Underlying Disorders, Clinical Phenotypes, and Treatment Diversity among Patients with Disseminated Intravascular
Hiroyuki Ohbe1, Kazuma Yamakawa2, Kohei Taniguchi3
1Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan.
Insights
Disseminated intravascular coagulation (DIC) phenotypes may not align with underlying causes or clinical outcomes like bleeding or organ failure. New strategies are needed to identify DIC phenotypes and personalize patient treatment.
Area of Science:
- Critical Care Medicine
- Hematology
- Internal Medicine
Background:
- Current clinical guidelines categorize disseminated intravascular coagulation (DIC) based on three phenotypes: bleeding, organ failure, or asymptomatic.
- However, the relationship between underlying disorders and clinical presentations of DIC, such as bleeding or organ failure, remains poorly documented.
Purpose of the Study:
- To investigate whether the underlying disorders associated with DIC influence clinical outcomes, including mortality, organ failure, and bleeding events.
- To evaluate the association between DIC underlying disorders and existing clinical phenotypes.
Main Methods:
- Utilized the Japanese Diagnosis Procedure Combination inpatient database from July 2010 to March 2018.
- Identified 337,132 adult patients diagnosed with DIC.
- Collected data on patient characteristics, underlying DIC disorders (sepsis, cancer, trauma, etc.), major bleeding events, and calculated organ failure scores.
Main Results:
- Sepsis (42%) and solid cancer (31%) were the most frequent underlying disorders for DIC.
- Patients with aortic diseases had the highest average organ failure score (2.8), followed by sepsis (2.2) and trauma (2.2).
- Major bleeding events were most common in patients with aortic diseases (24%), trauma (15%), and obstetric diseases (10%).
Conclusions:
- Clinical presentations of bleeding and organ failure in DIC patients were not significantly associated with the three established phenotypes or the underlying disorders.
- Current clinical presentation alone may be insufficient for accurately identifying DIC phenotypes.
- Further research is essential to develop novel strategies for DIC phenotype identification and tailored treatment approaches.
Introduction:
Clinical guidelines state that disseminated intravascular coagulation (DIC) treatment should be based on three clinical phenotypes: the marked bleeding type (e.g. leukemia, trauma, obstetric diseases, or aortic diseases); organ failure type (sepsis or pancreatitis); and asymptomatic type of DIC (solid cancer). However, among the various underlying disorders of DIC, the clinical presentations of bleeding or organ failure have not to date been well documented. The present study aimed to evaluate whether underlying disorders of DIC would affect clinical outcome including death, organ failure, and bleeding.
Methods:
Using the Japanese Diagnosis Procedure Combination inpatient database, we identified all adult patients diagnosed with DIC during hospitalization from July 1, 2010, to March 31, 2018. We collected data on patient characteristics and underlying disorders of DIC including sepsis, solid cancer, leukemia, trauma, obstetric diseases, aortic diseases, pancreatitis, and miscellaneous diseases. We counted major bleeding events and calculated an organ failure score for patients during hospitalization.
Results:
We identified 337,132 patients with DIC. The major disorders underlying DIC were sepsis (42%) and solid cancer (31%). The average organ failure scores of patients with aortic diseases, sepsis, and trauma were 2.8, 2.2, and 2.2, respectively. The percentages with major bleeding events among patients with aortic diseases, trauma, obstetric diseases, and solid cancer were 24%, 15%, 10%, and 10%, respectively.
Conclusions:
This study suggests that the clinical presentations of bleeding and organ failure are not associated with the three existing clinical phenotypes of DIC or with the underlying disorders of DIC. Therefore, clinical presentation alone may not be sufficient for identifying the clinical phenotypes of DIC. Further research is necessary to develop new strategies for identifying the phenotypes of DIC and improving treatment strategies for individual patients.
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