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Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: Results of a multicenter, prospective survey*

Gando, Satoshi MD, FCCM; Saitoh, Daizoh MD; Ogura, Hiroshi MD; Mayumi, Toshihiko MD; Koseki, Kazuhide MD; Ikeda, Toshiaki MD; Ishikura, Hiroyasu MD; Iba, Toshiaki MD; Ueyama, Masashi MD; Eguchi, Yutaka MD; Ohtomo, Yasuhiro MD; Okamoto, Kohji MD; Kushimoto, Shigeki MD; Endo, Shigeatsu MD; Shimazaki, Shuji MD Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group

doi: 10.1097/01.CCM.0000295317.97245.2D
Clinical Investigations
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Objective: To survey the natural history of disseminated intravascular coagulation (DIC) in patients diagnosed according to the Japanese Association for Acute Medicine (JAAM) DIC scoring system in a critical care setting.

Design: Prospective, multicenter study during a 4-month period.

Setting: General critical care center in a tertiary care hospital.

Patients: All patients were enrolled when they were diagnosed as DIC by the JAAM DIC scoring system.

Interventions: None.

Measurements and Main Results: Platelet counts, prothrombin time ratio, fibrinogen, and fibrin/fibrinogen degradation products were measured, and the systemic inflammatory response syndrome criteria met by the patients were determined following admission. Of 3,864 patients, 329 (8.5%) were diagnosed with DIC and the 28-day mortality rate was 21.9%, which was significantly different from that of the non-DIC patients (11.2%) (p < .0001). The progression of systemic inflammation, deterioration of organ function, and stepwise increase in incidence of the International Society on Thrombosis and Haemostasis (ISTH) DIC and its scores all correlated with an increase in the JAAM DIC score as demonstrated by the patients on day 0. There were significant differences in the JAAM DIC score and the variables adopted in the scoring system between survivors and nonsurvivors. The logistic regression analyses showed the JAAM DIC score and prothrombin time ratio on the day of DIC diagnosis to be predictors of patient outcome. The patients who simultaneously met the ISTH DIC criteria demonstrated twice the incidence of multiple organ dysfunction (61.1 vs. 30.5%, p < .0001) and mortality rate (34.4 vs. 17.2%, p = .0015) compared with those without the ISTH DIC diagnosis.

Conclusions: This prospective survey demonstrated the natural history of DIC patients diagnosed by the JAAM DIC diagnostic criteria in a critical care setting. The study provides further evidence of a progression from the JAAM DIC to the ISTH overt DIC.

National Hospital Organization, Kyoto Medical Center (HI); Department of Emergency Medicine, Juntendo University (TIb); Department of Traumatology, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital (MU); Critical and Intensive Care Medicine, Shiga University of Medical Science (YE); Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University (YO); Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health (KO); Department of Emergency and Critical Care Medicine, Nippon Medical School (SK); Department of Critical Care Medicine, School of Medicine, Iwate Medical University (SE); and Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine (SS).

Supported, in part, by the Japanese Association for Acute Medicine, Tokyo, Japan.

The authors have not disclosed any potential conflicts of interest.

Address requests for reprints to: Satoshi Gando, MD, FCCM, Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N17 W5, Kita-ku, Sapporo 060–8638 Japan. E-mail: gando@med.hokudai.ac.jp

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins