Satoshi Gando1, Seitaro Fujishima2, Daizoh Saitoh3, Atsushi Shiraishi4, Kazuma Yamakawa5, Shigeki Kushimoto6, Hiroshi Ogura7, Toshikazu Abe8, Toshihiko Mayumi9, Junichi Sasaki10, Joji Kotani11, Naoshi Takeyama12, Ryosuke Tsuruta13, Kiyotsugu Takuma14, Norio Yamashita15, Shin-Ichiro Shiraishi16, Hiroto Ikeda17, Yasukazu Shiino18, Takehiko Tarui19, Taka-Aki Nakada20, Toru Hifumi21, Yasuhiro Otomo22, Kohji Okamoto23, Yuichiro Sakamoto24, Akiyoshi Hagiwara25, Tomohiko Masuno26, Masashi Ueyama27, Satoshi Fujimi5, Yutaka Umemura7. 1. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Japan; Department of Acute and Critical Care Medicine, Sapporo Tokushukai Hospital, Japan. Electronic address: gandoicoud@icloud.com. 2. Center for General Medicine Education, Keio University School of Medicine, Japan. 3. Division of Traumatology, Research Institute, National Defense Medical College, Japan. 4. Emergency and Trauma Center, Kameda Medical Center, Japan. 5. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Japan. 6. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Japan. 7. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan. 8. Department of General Medicine, Juntendo University, Japan; Health Services Research and Development Center, University of Tsukuba, Japan. 9. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Japan. 10. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Japan. 11. Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Japan. 12. Advanced Critical Care Center, Aichi Medical University Hospital, Japan. 13. Advanced Medical Emergency & Critical Care Center, Yamaguchi University Hospital, Japan. 14. Emergency & Critical Care Center, Kawasaki Municipal Hospital, Japan. 15. Department of Emergency & Critical Care Medicine, School of Medicine, Kurume University, Japan. 16. Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Japan. 17. Department of Emergency Medicine, Trauma and Resuscitation Center, Teikyo University School of Medicine, Japan. 18. Department of Acute Medicine, Kawasaki Medical School, Japan. 19. Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Japan. 20. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Japan. 21. Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Japan. 22. Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Japan. 23. Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Japan. 24. Emergency and Critical Care Medicine, Saga University Hospital, Japan. 25. Center Hospital of the National Center for Global Health and Medicine, Japan. 26. Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan. 27. Community Healthcare Organization, Chukyo Hospital, Japan.
Abstract
BACKGROUND: Multiple organ dysfunction syndrome (MODS) is a predominant cause of death in acute respiratory distress syndrome (ARDS). Disseminated intravascular coagulation (DIC) is recognized as a syndrome that frequently develops MODS. To test the hypothesis that DIC scores are useful for predicting MODS development and that DIC is associated with MODS, we retrospectively analyzed the data of a prospective, multicenter study on ARDS. METHODS: Patients who met the Berlin definition of ARDS were included. DIC scores as well as the disease severity and the development of MODS on the day of the diagnosis of ARDS (day 0) and day 3 were evaluated. The primary and secondary outcomes were the development of MODS and the hospital mortality. RESULTS: In the 129 eligible patients, the prevalence of DIC was 45.7% (59/129). DIC patients were more seriously ill and exhibited a higher prevalence of MODS on days 0 and 3 than non-DIC patients. The DIC scores on day 0 detected the development of MODS with good area under the receiver operating characteristic curve (0.714, p<.001). DIC on day 0 was significantly associated with MODS on days 0 and 3 (odds ratio 1.53 and 1.34, respectively). Patients with persistent DIC from days 0 to 3 had higher rates of both MODS on day 3 (p=.035) and hospital mortality (p=.031) than the other patients. CONCLUSIONS: DIC scores were able to predict MODS, and DIC was associated with MODS during the early stage of ARDS. Persistent DIC may also have role in this association.
BACKGROUND:Multiple organ dysfunction syndrome (MODS) is a predominant cause of death in acute respiratory distress syndrome (ARDS). Disseminated intravascular coagulation (DIC) is recognized as a syndrome that frequently develops MODS. To test the hypothesis that DIC scores are useful for predicting MODS development and that DIC is associated with MODS, we retrospectively analyzed the data of a prospective, multicenter study on ARDS. METHODS:Patients who met the Berlin definition of ARDS were included. DIC scores as well as the disease severity and the development of MODS on the day of the diagnosis of ARDS (day 0) and day 3 were evaluated. The primary and secondary outcomes were the development of MODS and the hospital mortality. RESULTS: In the 129 eligible patients, the prevalence of DIC was 45.7% (59/129). DIC patients were more seriously ill and exhibited a higher prevalence of MODS on days 0 and 3 than non-DIC patients. The DIC scores on day 0 detected the development of MODS with good area under the receiver operating characteristic curve (0.714, p<.001). DIC on day 0 was significantly associated with MODS on days 0 and 3 (odds ratio 1.53 and 1.34, respectively). Patients with persistent DIC from days 0 to 3 had higher rates of both MODS on day 3 (p=.035) and hospital mortality (p=.031) than the other patients. CONCLUSIONS: DIC scores were able to predict MODS, and DIC was associated with MODS during the early stage of ARDS. Persistent DIC may also have role in this association.
Authors: Colin Pawlowski; Tyler Wagner; Arjun Puranik; Karthik Murugadoss; Liam Loscalzo; A J Venkatakrishnan; Rajiv K Pruthi; Damon E Houghton; John C O'Horo; William G Morice; Amy W Williams; Gregory J Gores; John Halamka; Andrew D Badley; Elliot S Barnathan; Hideo Makimura; Najat Khan; Venky Soundararajan Journal: Elife Date: 2020-08-17 Impact factor: 8.140
Authors: Upendra K Katneni; Aikaterini Alexaki; Ryan C Hunt; Tal Schiller; Michael DiCuccio; Paul W Buehler; Juan C Ibla; Chava Kimchi-Sarfaty Journal: Thromb Haemost Date: 2020-08-24 Impact factor: 5.249