PURPOSE:Severe sepsis is associated with activation of the coagulation cascade. While not all patients manifest overt DIC, virtually all have evidence of an evolving coagulopathy. We have previously shown that a simple evolving DIC score which looks at the absolute value and pattern of change in the prothrombin time and platelet count over the first 48 hours provides useful prognostic information. Since sepsis is a rapidly evolving process, we examined the utility of this simple evolving DIC score determined within the first 12 hours of ICU admission.
METHODS:Patients with severe sepsis in a university ICU were prospectively enrolled.Simple evolving DIC score was calculated by assigning 1 point for each of the following: a) platelet count of <100,000/mm3;b) decrease in platelet count of 20%;c) PT >15.0 secs; and d) increase in PT of > 0.3 secs. Patients with platelet counts <50,000/mm3 and PTs >20 secs were assigned 2 points in each category irrespective of whether there was a change from the previous value.
RESULTS:Patients were clinically classified as having capillary leak syndrome (CLS; n = 18), multiple organ failure with death from sepsis (n = 22), multiple organ failure with recovery (n = 39) or as well (n = 34) if they showed rapid improvement in their modified Multiple Organ Dysfunction Score (MODS). 86% of patients with severe sepsis showed evidence of evolving coagulopathy characterized by a simple score of ≥1. Mortality increased from 12% for a 12h simple score of 0 to 75% with a score of 4 (p = 0.03).The presence of severe coagulopathy characterized by a simple score of ≥3 at 12h identified high risk patients with > 50% mortality due to sepsis. The outcome predicted by the 12h simple score was similar to that predicted by the 48h simple score.
CONCLUSION:The simple evolving DIC score can be easily calculated at the bedside and provides early prognostic information.
CLINICAL IMPLICATIONS:Simple score at 12 hours may identify patients who benefit from additional therapeutic approaches.
DISCLOSURE:Jijo John, No Financial Disclosure Information; No Product/Research Disclosure Information