SESSION TYPE: Hematologic Problems in the ICU
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: Disseminating intravascular coagulation (DIC) is a devastating syndrome with major morbidity and mortality in the critically ill patients. An early diagnosis and accurate prognosis is important in improving DIC patient’s outcome. We aimed to determine the prognostic factors influencing the short term outcome of the critically ill patients with DIC.
METHODS: We conducted a population-based historical cohort study among consecutively admitted adult (≥18 years) DIC patients at the Mayo Clinic ICUs, from 2004 to 2010. DIC was diagnosed according to the International Society on Thrombosis and Hemostasis (ISTH) overt DIC algorithm. Patients who denied research authorization, those diagnosed with heparin induced thrombocytopenia, thrombotic thrombocytopenic purpura, Child Pugh class C or any known congenital coagulation disorders were excluded from the study. The prognostic factors included were patient’s demographics, comorbidities, APACHE III, Charlson and SOFA scores and risk factors for DIC. Multivariate logistic regression analysis was used to identify the independent risk factors associated with hospital death.
RESULTS: A total of 154 patients met the inclusion criteria, 61 (40%) females, median age of 63 yrs (IQR 52-76) and 128 (83%) were Caucasians. The median APACHE III score on first day of admission, Charlson index and SOFA scores on day one were 97 (IQR, 68 - 120), 3 (IQR, 1- 5) and 10 (IQR, 6 - 13) respectively. The ICU and hospital mortality was 27% and 51% respectively. On univariate analysis, age, Septic shock, acute respiratory failure (ARF), history of congestive heart failure (CHF) and diabetes with end-organ damage were associated with hospital mortality. In the multivariate logistic regression analysis, Septic shock (Odds ratio [OR] 2.27, 95% confidence interval [CI] 1.12 - 4.66), ARF (OR 2.28, 95% CI 1.15 - 4.58) and history of CHF (OR 3.57, 95% CI 1.26 - 11.8) were identified as the most important risk factors associated with in-hospital death .
CONCLUSIONS: Acute respiratory failure, Septic shock and history of congestive heart failure are independent risk factors for hospital mortality in DIC patients.
CLINICAL IMPLICATIONS: Early diagnosis, better management of ARF and Septic shock patients, along with history of CHF, may contribute better outcomes among DIC patients in the ICUs.
DISCLOSURE: The following authors have nothing to disclose: Balwinder Singh, Adil Ahmed, Rabe Alhurani, Andrew Hanson, Pablo Franco, Ognjen Gajic, Guangxi Li
No Product/Research Disclosure InformationMayo Clinic, Rochester, MN