To investigate the prognostic-power of simple evolving-D.I.C. score in ICU-patients with severe-sepsis in-terms of mortality and morbidity.In addition,this study aims at finding if there is possible correlation between increasing evolving D.I.C score and risk of organ dysfunction as measured by the modified organ dysfunction score(MODS).
Retrospective chart-analysis of adult ICU-patients with diagnosis of severe-sepsis over two-years period, who were expected to stay > 48 hrs in ICU & had platelet-count and prothrombin-time (PT) performed on admission and subsequent-days of their ICU-stay. The exclusion criteria was anticoagulant therapy, the presence of “do-not-resuscitate-order”, status-post cardiopulmonary-resuscitation, and significant pre-morbid conditions such as metastatic-cancer or underlying hematological disorder. Data collection was done for demo graphics, admission diagnoses, hospital&ICU-length of stay(LOS), ventilator-days (VD) and outcome in terms of death versus survival. MODS was taken at baseline, 48hrs later and at last-ICU-day. Platelet-count and PT in first ICU-day and 48hrs later were done. Simple evolving-D.I.C score (ES) ranged from 0 (normal) up to maximum-value of 4. One-point was given to each of the following values: an absolute-platelet-count less than100,000; PT > 15seconds, 20%-decrease in platelet-count, and > 0.3 seconds-increase in PT. Platelet-counts < 60,000/mm 3 and PT > 20 seconds were assigned two-points each. Study group was divided into two-groups: those with ES < or-equal to 2 versus those with ES > 2. The two-groups were compared for survival, LOS, VD and MODS.
360-charts were reviewed, 102-charts met study-criteria. Mean-age 62.8, male: female-ratio1:2, 99% African-American with overall-mortality-rate40%. 58-patients (57%) had ES-of equal or < 2compared to 44 patients (43%) with ES > than2.19%-of-patients with ES-equal or < 2 died versus 68%-of-patients with ES > 2died (P-value = 0.001). Hospital-LOS, ICU-LOS & VD were 14.3 days, 7.7 days & 2.8days; respectively for those with ES-equal or < 2 compared to 15.7 days, 8.8 days & 4.6 days; respectively for those with ES > 2(P-values were 0.361, 0.498 & 0.083; respectively). MODS-on admission, 48hours-later, at last ICU-day and mean-MODS were 6.4, 7.1, 7.0 & 6.7; respectively for those with ES > 2 compared with 5.0, 5.1, 3.3 & 4.6; respectively for those with ES equal or < 2 (P-values = 0.03, 0.02, 0.0001 & 0.0001; respectively). Linear-regression-analysis done for relationship of increasing-evolving-D.I.C.-score and mortality which showed strong correlation with P-value of0.0001, odds ratio-4.1;indicating significant increase in mortality with higher ES-scores.
ES in severe-sepsis has strong correlation with mortality & MODS.Increasing values of ES in critically-ill-patients with severe-sepsis measured over the first-48hours of admission to ICU carries higher-risk of dying and development of multiple-organ-dysfunction during ICU-stay.ES was not strong correlate to LOS or VD.
ES could be used as-marker of survival in ICU-patients with severe-sepsis.We suggest measuring platelet-count and PT in all ICU-patients with severe-sepsis on admission and 48hours later.
Fatimeh Syed, No Financial Disclosure Information; No Product/Research Disclosure Information