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Disseminated intravascular coagulation associated organ failure in obstetric patients admitted to intensive care
Zhiling Zhao1, Jianxin Zhang2, Nan Li3
1Department of Intensive Care Unit, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, People's Republic of China.
Insights
Disseminated intravascular coagulation (DIC) in obstetric patients significantly increases the risk of organ failure, particularly due to postpartum hemorrhage. Timely management of obstetric bleeding is crucial for improving patient outcomes.
Area of Science:
- Obstetrics and Gynecology
- Critical Care Medicine
- Hematology
Background:
- Disseminated intravascular coagulation (DIC) is a severe condition complicating obstetric care.
- Understanding the specific underlying diseases and organ failure patterns associated with obstetric DIC is essential for improving patient management and outcomes.
Purpose of the Study:
- To determine the incidence of DIC-associated organ failure in obstetric patients admitted to intensive care units (ICUs).
- To identify the primary underlying obstetric diseases leading to DIC and subsequent organ failure.
- To analyze the maternal outcomes, including organ function changes, mortality, and resource utilization, in obstetric patients with and without DIC.
Main Methods:
- Retrospective analysis of data from three tertiary hospital ICUs in China (2008-2016).
- Diagnosis of DIC confirmed using the International Society of Thrombosis and Hemostasis score (≥5).
- Inclusion of 297 ICU admissions for obstetric diseases, with 87 cases diagnosed with DIC.
Main Results:
- The incidence of DIC was 87 per 87,580 deliveries. Postpartum hemorrhage was the leading cause (81.6%), followed by hypertensive disorders (31.0%) and sepsis (17.2%).
- Patients with DIC exhibited significantly higher rates of multiple organ dysfunction syndrome/death (27.6% vs 4.8%), organ failure (36.8% vs 24.3%), acute renal failure (32.2% vs 10.0%), and disturbance of consciousness (12.6% vs 2.4%).
- DIC patients also required more massive transfusions (52.9% vs 21.9%), hysterectomies (32.2% vs 15.7%), and had longer ICU and hospital stays.
Conclusions:
- Postpartum hemorrhage is the primary driver of DIC-associated organ failure in critically ill obstetric patients.
- DIC and amniotic fluid embolism are independent risk factors for organ failure in this population.
- Prompt control of obstetric bleeding is vital for improving maternal prognoses and reducing organ failure incidence.
Abstract:
We aimed to determine disseminated intravascular coagulation (DIC)-associated organ failure and underlying diseases based on data from three ICU wards in tertiary hospitals in China from 2008 to 2016. The diagnosis of DIC was confirmed by an International Society of Thrombosis and Hemostasis score greater than or equal to 5. The maternal outcomes included the changes in organ function 24 h after ICU admission. The durations of hospital stay and ICU stay were recorded as secondary outcomes. Among 297 ICU admissions (median Sequential Organ Failure Assessment score, 4) for obstetric diseases, there were 87 DIC cases, with an estimated DIC incidence of 87 per 87,580 deliveries. Postpartum hemorrhage was the leading disease associated with DIC (71, 81.6%), followed by hypertensive disorders (27, 31.0%), sepsis (15, 17.2%), acute fatty liver of pregnancy (11, 12.6%) and amniotic fluid embolism (10, 11.5%). Compared with patients without DIC, those with DIC had higher rates of multiple organ dysfunction syndrome/death (27.6% vs 4.8%, p = 0.000), organ failure (36.8% vs 24.3%, p = 0.029), among which organ failure included acute renal failure (32.2% vs 10.0%, p = 0.000), respiratory failure (16.1% vs 8.6%, p = 0.057), disturbance of consciousness (12.6% vs 2.4%, p = 0.000) and DIC group also had higher rates of massive transfusion (52.9% vs 21.9%, p = 0.000), hysterectomy (32.2% vs 15.7%, p = 0.001), longer ICU (4 days vs 2 days, p = 0.000) and hospital stays (14 days vs 11 days, p = 0.005). DIC and amniotic fluid embolism were independent risk factors for organ failure in patients admitted to the ICU. Postpartum hemorrhage was the leading cause of DIC associated organ failure in obstetrics admitted to the ICU. The control of obstetric bleeding in a timely manner may improve obstetric prognoses.
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