PURPOSE: Sepsis is the most common disease associated with disseminated intravascular coagulation (DIC). To test the hypothesis that DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC scoring system constitutes a dependent continuum to the International Society on Thrombosis and Haemostasis (ISTH) overt DIC in patients with sepsis, we conducted a retrospective study.
METHODS: The databases from two prospective, multicenter clinical investigations were analyzed. The inclusion criteria comprised patients with sepsis-related DIC, who met the JAAM DIC criteria.
RESULTS: The present study enrolled 166 patients, of whom 67 met the ISTH overt DIC criteria. All patients with sepsis who developed to overt DIC during the study period could be identified by the JAAM DIC diagnostic criteria in the first study. While the overall 28-day mortality was 31.3%, mortality (40.3%, p = 0.0040) and the incidence of multiple organ dysfunction syndrome (70.1%, p = 0.008) of the patients with overt DIC was approximately one and a half times that of the patients associated with only the JAAM DIC. A stepwise increase in the ISTH DIC scores and the incidence of overt DIC were also observed in accordance with the increase in the JAAM DIC scores.
CONCLUSION: DIC diagnosed based on the JAAM DIC diagnostic criteria exists in a hierarchical continuum to overt DIC in patients with sepsis, enabling them to receive early treatment.
CLINICAL IMPLICATIONS: The present study demonstrated that the JAAM DIC is a hierarchical continuum to overt DIC in patients with sepsis. When JAAM DIC patients met the criteria of overt DIC, the risk for MODS and death was elevated by approximately one and a half times. These results indicate that the JAAM DIC scoring system is therefore useful selecting the patients with sepsis at a stage of stressed but compensated DIC, thereby enabling them to receive appropriate treatment in a timely manner.
DISCLOSURE: Satoshi Gando, Other This work was supported in part by fund from the Japanese Association for Acute Medicine.; No Product/Research Disclosure Information