J Korean Med Sci.  2016 Nov;31(11):1838-1845. 10.3346/jkms.2016.31.11.1838.

Performance Evaluation of Five Different Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Predicting Mortality in Patients with Complicated Sepsis

Affiliations
  • 1Department of Emergency Medicine, Hallym University Medical Center, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 2Department of Laboratory Medicine, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea.
  • 3Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
  • 4Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
  • 5Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea. ssjang@amc.seoul.kr

Abstract

Disseminated intravascular coagulation (DIC) is a major complication in sepsis patients. We compared the performance of five DIC diagnostic criteria, focusing on the prediction of mortality. One hundred patients with severe sepsis or septic shock admitted to intensive care unit (ICU) were enrolled. Routine DIC laboratory tests were performed over the first 4 days after admission. The overall ICU and 28-day mortality in DIC patients diagnosed from five criteria (International Society on Thrombosis and Haemostasis [ISTH], the Japanese Association for Acute Medicine [JAAM], the revised JAAM [R-JAAM], the Japanese Ministry of Health and Welfare [JMHW] and the Korean Society on Thrombosis and Hemostasis [KSTH]) were compared. Both KSTH and JMHW criteria showed superior performance than ISTH, JAAM and R-JAAM criteria in the prediction of overall ICU mortality in DIC patients (odds ratio 3.828 and 5.181, P = 0.018 and 0.006, 95% confidence interval 1.256-11.667 and 1.622-16.554, respectively) when applied at day 1 after admission, and survival analysis demonstrated significant prognostic impact of KSTH and JMHW criteria on the prediction of 28-day mortality (P = 0.007 and 0.049, respectively) when applied at day 1 after admission. In conclusion, both KSTH and JMHW criteria would be more useful than other three criteria in predicting prognosis in DIC patients with severe sepsis or septic shock.

Keyword

Criteria; Diagnosis; Disseminated Intravascular Coagulation; Mortality; Sepsis

MeSH Terms

Aged
Area Under Curve
Blood Platelets/cytology
Disseminated Intravascular Coagulation/complications/*diagnosis
Female
Fibrinogen/analysis
Humans
Intensive Care Units
Logistic Models
Male
Middle Aged
Odds Ratio
Partial Thromboplastin Time
Platelet Count
Prospective Studies
Prothrombin Time
ROC Curve
Sepsis/*complications/mortality
Severity of Illness Index
Survival Analysis
Systemic Inflammatory Response Syndrome/complications
Fibrinogen

Figure

  • Fig. 1 Comparison of five different DIC diagnostic criteria in terms of predicting 28-day mortality when applied at Day 1. Kaplan-Meier survival curve analysis shows that the KSTH (A) and JMHW (E) criteria could significantly predict 28-day mortality when applied at Day 1. However, ISTH (B), JAAM (C) and R-JAAM (D) criteria could not significantly predict 28-day mortality when applied at Day 1. ISTH = International Society on Thrombosis and Haemostasis, JAAM = Japanese Association for Acute Medicine, JMHW = Japanese Ministry of Health and Welfare, KSTH = Korean Society on Thrombosis and Hemostasis, R-JAAM = revised JAAM.


Cited by  1 articles

Prognostic Performance Evaluation of the International Society on Thrombosis and Hemostasis and the Korean Society on Thrombosis and Hemostasis Scores in the Early Phase of Trauma
Hong Sug Kim, Dong Hun Lee, Byung Kook Lee, Yong Soo Cho
J Korean Med Sci. 2018;33(3):.    doi: 10.3346/jkms.2018.33.e21.


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