Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman,Jordan

Abstract

Background:

The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients.

Methods:

In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC.

Results:

A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count (t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level (M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non–Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non–Overt DIC (χ² = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT (U = 2,298, z = 5.7, p < 0.001), PTT (U = 2,334, z = 2.0, p = 0.045) and INR (U = 2,541, z = 5.1, p < 0.001) compared to those with non–Overt DIC.

Conclusion:

The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Keywords

DIC score intensive care unit clinical factors ISTH

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References

Amit

Ravindra

Parineeta

Anjali

(2015). International society on thrombosis and haemostasis disseminated intravascular coagulation scoring system: Is it a good prognostic indicator in DIC. International Journal of Medical Research & Health Sciences, 4(3), 546–550.

Asakura

Takahashi

Uchiyama

Eguchi

Okamoto

Kawasugi

Wada

(2016). Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thrombosis Journal, 14(1), 42.

Bakhtiari

Meijers

J. C.

de Jonge

Levi

(2004). Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation. Critical Care Medicine, 32(12), 2416–2421. https://doi.org/10.1097/01.ccm.0000147769.07699.e3

Frazier

(2012). Disseminated intravascular coagulation and implications for medical -surgical nurses. Med-Surg Matters, 21(3/4), 8–11.

Gando

(2012). The utility of a diagnostic scoring system for disseminated intravascular coagulation. Critical Care Clinics, 28(3/4), 373–388.

Gando

Wada

Thachil

&Scientific and Standardization Committee on DIC of the International Society on Thrombosis and Haemostasis (ISTH). (2013). Differentiating disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype from coagulopathy of trauma and acute coagulopathy of trauma-shock (COT/ACOTS). Journal of Thrombosis and Haemostasis: JTH, 11(5), 826–835. https://doi.org/10.1111/jth.12190

Grafenedera

Krychtiukb

Buchtelea

Schoergenhofera

Gelbeneggera

Lenzb

Wojtab

(2020). The ISTH DIC score predicts outcome in non-septic patients admitted to a cardiovascular intensive care unit. European Journal of Internal Medicine, 79, 37–42.

S. O.

Park

S. H.

Hong

S. B.

Jang

(2016). Performance evaluation of five different disseminated intravascular coagulation (DIC) diagnostic criteria for predicting mortality in patients with complicated sepsis. Journal of Korean Medical Science, 31(11), 1838–1845.

Helms

Severac

Merdji

Clere-Jehl

François

Mercier

Quenot

J. P.

Meziani

& Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis (CRICS TRIGGERSEP) Group. (2020). Performances of disseminated intravascular coagulation scoring systems in septic shock patients. Annals of Intensive Care, 10(1), 92. https://doi.org/10.1186/s13613-020-00704-5

10.

Hifumi

Kondo

Shimazaki

Oda

Shiraishi

Wakasugi

Kawahara

(2018). Prognostic significance of disseminated intravascular coagulation in patients with heat stroke in a nationwide registry. Journal of Critical Care, 44, 306–311.

11.

Hjorleifsson

Sigurdsson

M. I.

Gudmundsdottir

B. R.

Sigurdsson

G. H.

Onundarson

P. T.

(2015). Prediction of survival in patients suspected of disseminated intravascular coagulation. Acta Anaesthesiologica Scandinavica, 59(7), 870–880.

12.

Huang

M. J.

Wei

R. B.

Wang

T. Y.

Q. P.

Chen

X. M.

(2017). Blood coagulation system in patients with chronic kidney disease: A prospective observational study. BMJ Open, 7(5), e014294.

13.

Iba

Nagaoka

Boulat

(2013). The anticoagulant therapy for sepsis-associated disseminated intravascular coagulation. Thrombosis Research, 131(5), 383–389. https://doi.org/10.1016/j.thromres.2013.03.012

14.

X. H.

(2015). Clinical values of combined detection of CRP and DD for AL patients complicated with DIC. Zhongguo Shiyanxueye Xuezazhi, 23(6), 1582–1585.

15.

Kander

Larsson

Taune

Schött

Tynngård

(2016). Assessment of haemostasis in disseminated intravascular coagulation by use of point–of–care assays and routine coagulation tests, in critically ill patients: A prospective observational study. PLoS One, 11(3), e0151202.

16.

Kelm

D. J.

Valerio-Rojas

J. C.

Cabello-Garza

Gajic

Cartin-Ceba

(2013). Predictors of disseminated intravascular coagulation in patients with septic shock. ISRN Critical Care, 2013, 219048.

17.

B. S.

Cho

H. Y.

Ryoo

S. M.

Kim

M. C.

Jung

Park

S. H.

Kim

W. Y.

(2016). The prevalence and significance of overt disseminated intravascular coagulation in patients with septic shock in the emergency department according to the third international consensus definition. Korean Journal of Critical Care Medicine, 31(4), 334–341.

18.

Kurosawa

Stearns-Kurosawa

D. J.

(2014). Complement, thrombotic microangiopathy and disseminated intravascular coagulation. Journal of Intensive Care, 2(1), 61.

19.

Lee

Kim

J. E.

Kwon

Kim

Yoon

S. S.

Park

Kim

H. K.

(2014). Poor prognosis of hypocoagulability assessed by thrombin generation assay in disseminated intravascular coagulation. Blood Coagulation & Fibrinolysis, 25(3), 241–247.

20.

Levi

(2014). Diagnosis and treatment of disseminated intravascular coagulation. International Journal of Laboratory Hematology, 36(3), 228–236.

21.

W. J.

Sha

Zhang

Z. P.

Y. J.

Shi

D. M.

(2016). Efficacy evaluation of D-dimer and modified criteria in overt and nonovert disseminated intravascular coagulation diagnosis. International Journal of Laboratory Hematology, 38(2), 151–159.

22.

Mehta

George

J. V.

Mehta

Ali

M. T.

Singh

M. K.

(2016). Incidence and risk factors for thrombocytopenia in the intensive care units of a tertiary hospital in northern India. Southern African Journal of Critical Care (Online), 32(1), 28–31.

23.

Murata

Okamoto

Mayumi

Muramatsu

Matsuda

(2016). Recent change in treatment of disseminated intravascular coagulation in Japan: An epidemiological study based on a National Administrative Database. Clinical and Applied Thrombosis/Hemostasis, 22(1), 21–27.

24.

Rostom

Khaled

Afify

Ahmed

E. S.

(2013). Applications of the international scoring system for Disseminated Intravascular Coagulopathy (DIC) and its interaction with Sequential Organ Failure Assessment Score (SOFA) in prediction of prognosis and final outcome in ICU. The Egyptian Journal of Critical Care Medicine, 1(1), 33–41.

25.

Singh

Hanson

A. C.

Alhurani

Wang

Herasevich

Cartin-Ceba

(2013). Trends in the incidence and outcomes of disseminated intravascular coagulation in critically ill patients (2004–2010): A population–based study. CHEST Journal, 143(5), 1235–1242.

26.

Singh

Pati

H. P.

Tyagi

Upadhyay

A. D.

Saxena

(2015). Evaluation of the diagnostic performance of fibrin monomer in comparison to d–dimer in patients with overt and nonovert disseminated intravascular coagulation. Clinical and Applied Thrombosis/Hemostasis, 23(5), 460–465.

27.

Sohn

C. H.

Kim

S. R.

Kim

Y. J.

Seo

D. W.

Ahn

Lee

Y. S.

Lim

K. S.

(2017). Disseminated intravascular coagulation in emergency department patients with primary postpartum hemorrhage. Shock, 48(3), 329–332.

28.

Spring

J. L.

Winkler

Levy

J. H.

(2014). The influence of various patient characteristics on D–dimer concentration in critically ill patients and its role as a prognostic indicator in the intensive care unit setting. Clinics in Laboratory Medicine, 34(3), 675–686.

29.

Takemitsu

Wada

Hatada

Ohmori

Ishikura

Takeda

Isaji

(2011). Prospective evaluation of three different diagnostic criteria for disseminated intravascular coagulation. Thrombosis and Haemostasis, 105(1), 40–44.

30.

Tamara

T. F.

Allam

I. F. S. E. D.

El-Ghazaly

T. E. S. M.

Ali Ahmed

M. A.

(2016). The fibrinogen/CRP ratio as a new parameter for the prediction of disseminated intravascular coagulation in patients with HELLP syndrome. The Egyptian Journal of Hospital Medicine, 65(1), 634–642.

31.

Taylor

F. B.

Toh

C. H.

Hoots

W. K.

Wada

Levi

(2001). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thrombosis and Haemostasis, 86(5), 1327–1330.

32.

Umemura

Yamakawa

Hayakawa

Hamasaki

Fujimi

(2018). Screening itself for disseminated intravascular coagulation may reduce mortality in sepsis: A nationwide multi-center registry in Japan. Thrombosis Research, 161, 60–66.

33.

Wada

Matsumoto

Yamashita

(2014). Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. Journal of Intensive Care, 2(1), 15.

34.

Wada

Thachil

Nisio

Mathew

Kurosawa

Gando

Toh

C. H.

(2013). Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of the recommendations from three guidelines. Journal of Thrombosis and Haemostasis, 11(4), 761–767.

35.

Wang

Kou

Deng

Wang

Guo

Mei

. (2015). Retrospective evaluation of new chinese diagnostic scoring system for disseminated intravascular coagulation. PLoS ONE 10(6), e0129170. https://doi.org/10.1371/journal.pone.0129170

36.

Zhao

Chen

Y. X.

C. S.

(2015). Predictive value of the complement system for sepsis–induced disseminated intravascular coagulation in septic patients in emergency department. Journal of Critical Care, 30(2), 290–295.