Toshiaki Iba1, Makoto Arakawa1, Marcello Di Nisio2, Satoshi Gando3, Hideaki Anan4, Koichi Sato5, Yutaka Ueki6, Jerrold H Levy7, Jecko Thachil8. 1. Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, Japan. 2. Department of Medicine and Ageing Sciences, University G.D'Annunzio of Chieti-Pescara, Chieti, Italy. 3. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Tokyo, Japan. 4. Emergency Medical Center, Fujisawa City Hospital, Tokyo, Japan. 5. Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University Graduate School of Medicine, Hongo Bunkyo-ku, Tokyo, Japan. 6. Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, Bunkyō, Tokyo, Japan. 7. Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC, USA. 8. Department of Haematology, Manchester Royal Infirmary, Manchester, United Kingdom.
Abstract
BACKGROUND: Disseminated intravascular coagulation (DIC) has been recognized as an urgent and critical condition in patients with sepsis. Therefore, unfamiliar and time-consuming tests or a complex scoring system are not suitable for diagnosis. Sepsis-induced coagulopathy (SIC), a newly proposed category delineated by a few global coagulation tests, has been established as an early warning sign for DIC. The purpose of this study was to elucidate the characteristics of SIC, especially in relation to the score of the International Society on Thrombosis and Haemostasis (ISTH) for overt DIC. METHOD: A data set for 332 patients with sepsis who were suspected to have DIC, antithrombin activity <70%, and treated with antithrombin substitution was utilized to examine the relationship between SIC and overt DIC. The performance of SIC calculated at baseline (ie, before treatment) as well as on days 2, 4, or 7 was analyzed in terms of its ability to predict 28-day mortality and overt DIC. RESULTS: At baseline, 149 (98.7%) of 151 patients with overt DIC according to the ISTH definition were diagnosed as having SIC. Of the 49, 46 (93.9%) patients who developed overt DIC between days 2 and 4 had received a prior diagnosis of SIC. The sensitivity of baseline SIC for the prediction of death was significantly higher than that of overt DIC (86.8% vs 64.5%, P < .001). The sensitivity of SIC on days 2, 4, and 7 was significantly higher than those of overt DIC (96.1%, 92.3%, and 84.4% vs 67.1%, 57.7%, and 50.0%, P < .001, .001, and .001, respectively), although the specificity of SIC was lower at all time points.
BACKGROUND: Disseminated intravascular coagulation (DIC) has been recognized as an urgent and critical condition in patients with sepsis. Therefore, unfamiliar and time-consuming tests or a complex scoring system are not suitable for diagnosis. Sepsis-induced coagulopathy (SIC), a newly proposed category delineated by a few global coagulation tests, has been established as an early warning sign for DIC. The purpose of this study was to elucidate the characteristics of SIC, especially in relation to the score of the International Society on Thrombosis and Haemostasis (ISTH) for overt DIC. METHOD: A data set for 332 patients with sepsis who were suspected to have DIC, antithrombin activity <70%, and treated with antithrombin substitution was utilized to examine the relationship between SIC and overt DIC. The performance of SIC calculated at baseline (ie, before treatment) as well as on days 2, 4, or 7 was analyzed in terms of its ability to predict 28-day mortality and overt DIC. RESULTS: At baseline, 149 (98.7%) of 151 patients with overt DIC according to the ISTH definition were diagnosed as having SIC. Of the 49, 46 (93.9%) patients who developed overt DIC between days 2 and 4 had received a prior diagnosis of SIC. The sensitivity of baseline SIC for the prediction of death was significantly higher than that of overt DIC (86.8% vs 64.5%, P < .001). The sensitivity of SIC on days 2, 4, and 7 was significantly higher than those of overt DIC (96.1%, 92.3%, and 84.4% vs 67.1%, 57.7%, and 50.0%, P < .001, .001, and .001, respectively), although the specificity of SIC was lower at all time points.
Authors: Annalisa Boscolo; Luca Spiezia; Elena Campello; Elisabetta Maria Consolaro; Carlo Ori; Paolo Simioni Journal: Intern Emerg Med Date: 2019-07-02 Impact factor: 3.397