OBJECTIVE: To assess the prevalence, characteristics and prognosis of overt disseminated intravascular coagulation (DIC) in adult emergency department (ED) patients and identify markers of poor outcome. MATERIALS AND METHODS: In a chart review study, we analysed the occurrence of overt DIC in all patients (n=1 001 727) attending the University's ED from 2003 to 2014 applying the ISTH DIC score. The primary outcome measure was 30-day mortality. Logistic regression analysis was used to determine predictors of mortality. RESULTS: The initial inter-rater reliability in the diagnosis of DIC was 0.85 [κ; 95% confidence interval (CI), 0.77-0.92]. The main DIC precipitators were malignancy (47%), cardiovascular diseases (CVD, 27%) and sepsis (16%). Hyperfibrinolytic DIC occurred in 27% of patients and was over-represented in those with cardiac arrest (68%). Thirty-day mortality (52%) was inversely associated with fibrinogen levels on admission [adjusted odds ratio, 0.49; 95% CI: 0.30-0.82; P=0.006]. Afibrinogenaemia implied an even 10-fold increased risk of dying (crude odds ratio, 10.0; 95% CI: 3.2-31.4; P<0.001). D-dimer and platelet count had no predictive value. Appropriate ICD-10 coding for DIC was present in only 1.8% of cases. CONCLUSION: Overt DIC is a rare but underdiagnosed event in ED patients. In this collective, cardiac arrest is a dominant cause of DIC presenting with a fibrinolytic phenotype. The degree of hypofibrinogenaemia on admission strongly and linearly predicted early death.
OBJECTIVE: To assess the prevalence, characteristics and prognosis of overt disseminated intravascular coagulation (DIC) in adult emergency department (ED) patients and identify markers of poor outcome. MATERIALS AND METHODS: In a chart review study, we analysed the occurrence of overt DIC in all patients (n=1 001 727) attending the University's ED from 2003 to 2014 applying the ISTH DIC score. The primary outcome measure was 30-day mortality. Logistic regression analysis was used to determine predictors of mortality. RESULTS: The initial inter-rater reliability in the diagnosis of DIC was 0.85 [κ; 95% confidence interval (CI), 0.77-0.92]. The main DIC precipitators were malignancy (47%), cardiovascular diseases (CVD, 27%) and sepsis (16%). Hyperfibrinolytic DIC occurred in 27% of patients and was over-represented in those with cardiac arrest (68%). Thirty-day mortality (52%) was inversely associated with fibrinogen levels on admission [adjusted odds ratio, 0.49; 95% CI: 0.30-0.82; P=0.006]. Afibrinogenaemia implied an even 10-fold increased risk of dying (crude odds ratio, 10.0; 95% CI: 3.2-31.4; P<0.001). D-dimer and platelet count had no predictive value. Appropriate ICD-10 coding for DIC was present in only 1.8% of cases. CONCLUSION: Overt DIC is a rare but underdiagnosed event in ED patients. In this collective, cardiac arrest is a dominant cause of DIC presenting with a fibrinolytic phenotype. The degree of hypofibrinogenaemia on admission strongly and linearly predicted early death.
Authors: Leonora R Slatnick; Dianne Thornhill; Sara J Deakyne Davies; James B Ford; Halden F Scott; Marilyn J Manco-Johnson; Beth Boulden Warren Journal: J Pediatr Date: 2020-06-14 Impact factor: 4.406
Authors: Filippo Cacioppo; Michael Schwameis; Nikola Schuetz; Julia Oppenauer; Sebastian Schnaubelt; Alexander Simon; Martin Lutnik; Sophie Gupta; Dominik Roth; Harald Herkner; Alexander Oskar Spiel; Anton Norbert Laggner; Hans Domanovits; Jan Niederdoeckl Journal: Int J Environ Res Public Health Date: 2022-05-28 Impact factor: 4.614
Authors: Anne E Merrelaar; Magdalena S Bögl; Nina Buchtele; Marieke Merrelaar; Harald Herkner; Christian Schoergenhofer; Job Harenberg; Jonathan Douxfils; Romain Siriez; Bernd Jilma; Alexander O Spiel; Michael Schwameis Journal: Thromb Haemost Date: 2022-07-04 Impact factor: 6.681