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Original Research: Critical Care |

Trends in the Incidence and Outcomes of Disseminated Intravascular Coagulation in Critically Ill Patients (2004-2010)Trends in Disseminated Intravascular Coagulation: A Population-Based Study

Balwinder Singh, MBBS; Andrew C. Hanson, BS; Rabe Alhurani, MBBS; Shihan Wang, MD, PhD; Vitaly Herasevich, MD, PhD; Rodrigo Cartin-Ceba, MD; Daryl J. Kor, MD; Naseema Gangat, MBBS; Guangxi Li, MD
Author and Funding Information

From Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) (Drs Singh, Alhurani, Herasevich, Cartin-Ceba, Kor, and Li and Mr Hanson); the Department of Medicine (Drs Singh, Alhurani, Wang, Cartin-Ceba, and Li), Division of Pulmonary and Critical Care Medicine; the Department of Health Sciences Research (Mr Hanson); the Department of Anesthesiology (Drs Herasevich and Kor), Division of Critical Care Medicine; and the Department of Medicine (Dr Gangat), Division of Hematology, Mayo Clinic, Rochester, MN; and Guang An Men Hospital (Drs Wang and Li), China Academy of Chinese Medical Science, Beijing, China.

Correspondence to: Guangxi Li, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: li.guangxi@mayo.edu


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(5):1235-1242. doi:10.1378/chest.12-2112
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Background:  The incidence and outcomes of disseminated intravascular coagulation (DIC) are incompletely defined. Therefore, we aimed to evaluate the trends in incidence and outcomes of critically ill patients with DIC.

Methods:  We conducted a population-based, retrospective cohort study evaluating consecutively admitted adult (≥ 18 years old) critically ill patients with DIC at the Mayo Clinic, Minnesota, from 2004 to 2010. DIC was diagnosed according to the International Society on Thrombosis and Hemostasis’ overt DIC algorithm. Patients given a diagnosis of heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, Child Pugh class C, or any known congenital or acquired coagulation disorders were excluded.

Results:  Of the 8,089 Olmsted County resident ICU admissions, a total of 154 patients met the DIC inclusion criteria. The overall incidence rate of DIC/100,000 person-years decreased from 26.2 (95% CI, 17.1-38.4) in 2004 to 18.6 (95% CI, 11.3-28.7) in 2010. The incidence rate of DIC increased with age in both men and women and was consistently higher in men, with the exception of the age group 18 to 39 years. The incidence rate/100,000 person-years of DIC in men decreased from 41.6 (95% CI, 25.4-64.2) in 2004 to 21.2 (95% CI, 10.6 37.9) in 2010 (P = .01), whereas in women, it did not change significantly (P = .79). The case fatality rate did not change significantly during the study period.

Conclusions:  The incidence of DIC has decreased over the past decade, significantly in men, although the mortality rate remains the same. This is in agreement with trends in other critical care syndromes and could be attributable to improvements in health care delivery.

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