Satoshi Gando1, Atsushi Shiraishi2, Kazuma Yamakawa3, Hiroshi Ogura4, Daizoh Saitoh5, Seitaro Fujishima6, Toshihiko Mayumi7, Shigeki Kushimoto8, Toshikazu Abe9, Yasukazu Shiino10, Taka-Aki Nakada11, Takehiko Tarui12, Toru Hifumi13, Yasuhiro Otomo14, Kohji Okamoto15, Yutaka Umemura4, Joji Kotani16, Yuichiro Sakamoto17, Junichi Sasaki18, Shin-Ichiro Shiraishi19, Kiyotsugu Takuma20, Ryosuke Tsuruta21, Akiyoshi Hagiwara22, Tomohiko Masuno23, Naoshi Takeyama24, Norio Yamashita25, Hiroto Ikeda26, Masashi Ueyama27, Satoshi Fujimi3. 1. Department of Anesthesiology and Critical Medicine, Hokkaido University Graduate School of Medicine, Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Japan. Electronic address: gandoicoud@icloud.com. 2. Emergency and Trauma Center, Kameda Medical Center, Japan. 3. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan. 4. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan. 5. Division of Traumatology, Research Institute, National Defense Medical College, Japan. 6. Center for General Medicine Education, Keio University School of Medicine, Japan. 7. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan. 8. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan. 9. Department of General Medicine, Juntendo University, Health Services Research and Development Center, University of Tsukuba, Japan. 10. Department of Acute Medicine, Kawasaki Medical School, Japan. 11. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Japan. 12. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Japan. 13. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan. 14. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Japan. 15. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Japan. 16. Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan. 17. Emergency and Critical Care Medicine, Saga University Hospital, Japan. 18. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Japan. 19. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Japan. 20. Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Japan. 21. Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Japan. 22. Center Hospital of the National Center for Global Health and Medicine, Japan. 23. Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan. 24. Advanced Critical Care Center, Aichi Medical University Hospital, Japan. 25. Advanced Emergency Medical Service Center Kurume University Hospital, Japan. 26. Department of Emergency Medicine, Teikyo University School of Medicine, Japan. 27. Department of Trauma, Critical Care Medicine, and Burn Center, Japan Community Healthcare Organization, Chukyo Hospital, Japan.
Abstract
BACKGROUND: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. OBJECTIVES: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. METHODS: Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. RESULTS: The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. CONCLUSIONS: The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.
BACKGROUND: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. OBJECTIVES: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. METHODS: Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. RESULTS: The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. CONCLUSIONS: The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.
Authors: Yan-Qiu Han; Li Yan; Lei Zhang; Pei-Heng Ouyang; Peng Li; Giuseppe Lippi; Zhi-De Hu Journal: Biochem Med (Zagreb) Date: 2021-06-15 Impact factor: 2.313