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Predicting mortality in patients with disseminated intravascular coagulation after cardiopulmonary bypass surgery by utilizing two scoring systems

Demma, Linda J.a; Faraoni, Davidb; Winkler, Anne M.c; Iba, Toshiakid; Levy, Jerrold H.e

Blood Coagulation & Fibrinolysis: January 2019 - Volume 30 - Issue 1 - p 11–16
doi: 10.1097/MBC.0000000000000781
ORIGINAL ARTICLES
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We evaluated clinical and laboratory biomarkers of disseminated intravascular coagulation (DIC) following cardiac surgery in the cardiothoracic surgical ICU (CTICU) to predict mortality. We retrospectively analyzed CTICU patients with suspected DIC identified from the hospital laboratory database, and calculated International Society on Thrombosis and Haemostasis (ISTH) and the Japanese Association for Acute Medicine (JAAM) DIC scores to predict DIC-related mortality. The predictive accuracy of the JAAM and ISTH DIC scoring system were then assessed by logistic regression analysis and receiver operative characteristics analysis, and compared to other potential predictors of mortality (e.g., Acute Physiology and Chronic Health Evaluation II, systemic inflammatory response syndrome criteria, laboratory variables). Our study showed a 30-day mortality rate of 71% in CTICU patients with DIC. The JAAM DIC score offered the best predictive accuracy [area under the curve (AUC): 0.723, 95% % confidence interval (CI): 0.638–0.947, P = 0.021], when compared with ISTH DIC score (AUC: 0.707, 95% CI: 0.491–0.923, P = 0.066) and Acute Physiology and Chronic Health Evaluation II (AUC: 0.687, 95% CI: 0.483–0.891, P = 0.110). A JAAM DIC score at least 6 was reported in 89% of the nonsurvivors and 46% of survivors (P = 0.010), and predicted mortality [odds ratio: 9.33 (1.50–58.20)] with a 73% sensitivity and a 78% specificity. Our results also show a strong relationship between acid–base derangement and mortality. This initial evaluation of DIC-related mortality in the CTICU found the standardized JAAM DIC scoring system in combination with acid–base laboratory values were most useful to predict mortality in postcardiac surgery patients with DIC. Additional prospective studies are needed to further validate our findings.

aDepartment of Anesthesiology, Emory Healthcare, Emory University School of Medicine, Atlanta, Georgia

bDepartment of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada

cDepartment of Pathology, Emory Healthcare, Emory University School of Medicine, Atlanta, Georgia

dDepartment of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan

eDepartments of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina, USA

Correspondence to Jerrold H. Levy, MD, FAHA, FCCM, Duke University Medical Center, 2301 Erwin Rd., 5691H HAFS, Box 3094, Durham, NC 27710, USA Tel: +1 919 684 0862; fax: +1 919 681 8994; e-mail: jerrold.levy@duke.edu

Received 6 July, 2018

Accepted 22 October, 2018

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