Overt disseminated intravascular coagulopathy (DIC) is uncommon in patients with severe sepsis, but, when present, DIC is associated with increased mortality. Recently the International Society on Thrombosis and Haemostasis proposed a category of non-overt or evolving DIC, which incorporates the changes in coagulation parameters into the evolving DIC score. We sought to determine the applicability and prognostic significance of evolving DIC.
This was a prospective observational study of 137 adult patients admitted to the intensive care unit at the University of Oklahoma, Health Sciences Center or the Oklahoma City VA medical center with the diagnosis of severe sepsis for whom informed consent was obtained. Six patients who died within the first 48 hours were excluded. An evolving DIC score 0 to 4, (0 being normal) was given to each patient with 1 point for each of the following: 20% decrease in platelet count (PC); an increase in PT >0.3 sec; an absolute PC<100,000; and PT > 14.5 sec. Data are presented as mean ± SEM. A p value <0.05 was considered statistically significant.
Age, gender, temperature, WBC count, and Hemoglobin (Hgb) were similar in all groups. A higher evolving DIC score was associated with a higher APACHE II, MODS score, LDH, lactic acid, SGOT, and, a lower plasma HCO3 and pH level (table 1Table-1
DIC ClassVariable0 (n=32)1 (n=32)2 (n=29)3 (n=21)4 (n=17)APACHE II22±223±126±128±1.4*33±1.5*MODS7±0.67.4±0.59±0.610±0.6*12.4±1*Serum HCO324±218±1.319±1.417±1*16±2*Lactic acid1.9±0.32.5±0.34.4±1*5.6±1*6.2±1*Pressors %5844527590Mortality %1516488194*
p<0.005 (Comparisons for all pairs using Tukey-Kramer HSD)). Increased DIC score also was associated with increased mortality, pressors requirements and mutiorgan failure. There was also a trend for increased heart rate, BUN, and creatinine, and a lower blood pressure, and Glasgow Coma Score with increased DIC score. An evolving DIC score > 2 at 72 hours had an 81 % sensitivity and 73% specificity of predicting mortality in patients with severe sepsis.
An increased DIC score was associated with increased mortality and morbidity.
The evolving DIC score which takes into account the absolute value and change in PT and PC is simple, easy to use and a good predictor of clinical outcome.
J.G. Zein, None.