Outcome of disseminated intravascular coagulation in relation to the score when treatment was begun. Mie DIC Study Group
Related Experiment Videos
12nd Department of Internal Medicine, Mie University School of Medicine, Tsu-city, Japan.
Insights
Early diagnosis and treatment of disseminated intravascular coagulation (DIC) improve outcomes. Key hemostatic indicators aid early detection, with leukemic patients showing better treatment response than non-leukemic ones.
Area of Science:
- Hematology
- Pathophysiology
- Clinical Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome with variable outcomes.
- The influence of underlying disease and early diagnostic markers on DIC treatment efficacy requires further elucidation.
Purpose of the Study:
- To investigate the efficacy of DIC treatment based on underlying disease (leukemic vs. non-leukemic).
- To identify key hemostatic indicators for diagnosing pre-DIC and predicting treatment outcomes.
- To evaluate the impact of early diagnosis and treatment timing on patient outcomes.
Main Methods:
- Retrospective analysis of 395 patients with DIC, categorized into leukemic and non-leukemic groups.
- Examination of hemostatic indicators including prothrombin time (PT) ratio, FDP, platelet count, fibrinogen, fibrin-D-dimer, thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), antithrombin, plasminogen, and thrombomodulin.
- Correlation of diagnostic and prognostic indicators with DIC scores and treatment outcomes.
Main Results:
- Overall treatment success (remission) was 58%, with 31% experiencing exacerbation or death.
- Leukemic patients demonstrated a better treatment response compared to non-leukemic patients.
- Plasma levels of fibrin-D-dimer, TAT, and PPIC were elevated in pre-DIC, while PT ratio, FDP, platelet count, and fibrinogen were diagnostic for DIC.
- Earlier treatment initiation (pre-DIC) yielded greater efficacy than treatment of established DIC.
- Poor outcomes were associated with high PT ratio, low antithrombin and plasminogen, high PPIC, low PPIC/TAT ratio, and high thrombomodulin, suggesting factor consumption, liver dysfunction, hypofibrinolysis, or organ failure.
Conclusions:
- The underlying disease significantly influences DIC treatment outcomes, with leukemic patients responding better.
- Early detection of pre-DIC using markers like fibrin-D-dimer, TAT, and PPIC is crucial for effective intervention.
- Timely initiation of treatment, guided by specific hemostatic indicators, is paramount for improving patient prognosis in DIC.
Abstract:
We examined 395 patients with disseminated intravascular coagulation (DIC) divided into two groups: non-leukemic and leukemic. In 58% of the patients as a whole, treatment of DIC resulted in complete or partial remission, while exacerbation and death occurred in 31%. The efficacy of DIC treatment in the non-leukemic group was less than that in the leukemic group, indicating that the outcome of DIC depended, in part, on the underlying disease. We examined hemostatic indicators in relation to DIC score: prothrombin time (PT) ratio, FDP, platelet count, and fibrinogen levels were found to be important indicators for the diagnosis of DIC, but not for Pre-DIC. Plasma levels of fibrin-D-dimer, thrombin-antithrombin complex (TAT), and plasmin-plasmin inhibitor complex (PPIC) were significantly increased in pre-DIC. The efficacy of treatment in relation to the DIC score when the treatment was begun showed that greater efficacy was achieved in pre-DIC than in DIC patients. The outcome was poorer with increasing DIC score, suggesting that early diagnosis and early treatment are important. On examining the relationship between outcome and hemostatic indicators, we found that the PT ratio and the levels of antithrombin, plasminogen, PPIC, the PPIC/TAT ratio, and thrombomodulin were related to outcome, suggesting that very high consumption of blood coagulation factors, liver dysfunction, hypofibrinolysis, or organ failure caused a poor outcome. Although the outcome in DIC patients may not depend substantially on plasma levels of TAT and fibrin-D-dimer, we can use these indicators to treat DIC patients at an early stage.