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Study of Various Disseminated Intravascular Coagulation Scores and Sequential Organ Failure Assessment Score in
Madhulika L Mahashabde1, Jugal Sriram1
1General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND.
Insights
This study found that higher disseminated intravascular coagulation (DIC) scores, including ISTH and SOFA scores, correlate with increased mortality in intensive care patients. A stable or decreasing DIC score indicates a better prognosis for critically ill patients.
Area of Science:
- Critical Care Medicine
- Hematology
- Infectious Diseases
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome impacting critically ill patients.
- Accurate assessment of DIC and its correlation with prognostic scores is crucial for patient management in intensive care units.
- Existing scoring systems like ISTH, SIC, and SOFA require further validation in diverse patient populations.
Purpose of the Study:
- To evaluate disseminated intravascular coagulation (DIC) in medical intensive care unit (MICU) patients.
- To assess the correlation between DIC scores (ISTH, SIC) and the Sequential Organ Failure Assessment (SOFA) score.
- To determine the prognostic value of these scores in predicting outcomes for critically ill patients.
Main Methods:
- A prospective study involving 100 MICU patients with a qSOFA score was conducted over two years.
- Clinical data, laboratory values, and validated scoring systems (ISTH, SIC, SOFA) were collected and analyzed.
- Statistical analysis compared scores between survivors and non-survivors to identify significant correlations.
Main Results:
- The study population had an average age of 52.08 years, with 65% males.
- A significant correlation was observed between higher ISTH, SIC, and SOFA scores and increased mortality.
- Mortality was significantly associated with DIC in 57.15% of cases, with notable differences in SOFA scores over time between survivors and non-survivors.
Conclusions:
- Higher ISTH, SIC, and SOFA scores are positively linked, indicating a poorer prognosis in critically ill patients.
- Progressive increases in DIC scores correlate with negative patient outcomes, while stable or declining scores suggest a favorable prognosis.
- No significant association was found between non-overt DIC and mortality.
Abstract:
Aim The aim of the present study was to assess the disseminated intravascular coagulation (DIC) and its correlation with DIC scores (International Society on Thrombosis and Haemostasis (ISTH), sepsis-induced coagulopathy (SIC)) and Sequential Organ Failure Assessment (SOFA) score in medical intensive care unit (MICU) patients. Methods The study was conducted at the medical intensive care unit at Dr. D.Y. Patil Medical College and Hospital, D.Y. Patil Vidyapeeth, Pimpri, Pune spanning from October 2020 to September 2022. A total of 100 patients admitted to the hospital ICU satisfying qSOFA score were included in the current study. Approval was obtained from the institutional ethics committee before commencing the study. All patients and their family members included in the study were provided with a detailed explanation of the study. Clinical history of illness and physical examination were done in detail. The laboratory values were obtained and were calculated with the International Society on Thrombosis and Haemostasis (ISTH), sepsis-induced coagulopathy (SIC) and Sequential Organ Failure Assessment (SOFA) scores. Results The average age of the study population was 52.08 ± 16.44 years. Within the study population, 65% were male and 35% were female. Within the group being studied, the average pulse rate was 66.64 ± 17.33 beats per minute, the average systolic blood pressure was 83.7 ± 11.38 mm Hg, the average diastolic blood pressure was 59.7 ± 10.49 mm Hg, and the average respiratory rate was 38.4 ± 4.8. The average Glasgow Coma Scale (GCS) among the participants was 9.51 ± 1.74. The average qSOFA score across the study participants was 2.58 ± 0.6. The study population consisted of 60% survivors and 40% non-survivors. Regarding the study population, 57.15% of individuals experienced mortality as a result of DIC. The statistical analysis revealed a significant difference in the mean ISTH score between the result groups at 48 hours. The disparity in the average SOFA score at admission, 24 hours, 48 hours, day 7 and day 14 between the outcomes (survivors and non-survivors) was statistically significant. Conclusion This research suggests that there is a positive link between higher scores on the estimated ISTH, SIC and SOFA scales. The prognosis of critically sick patients is negatively correlated with the progressive increase in DIC scores throughout follow-up, while a stable or declining DIC score is indicative of a more favorable prognosis. There was no significant link seen between non-overt disseminated intravascular coagulation (DIC) mortality and DIC scores.
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