A Prospective Analysis of Disseminated Intravascular Coagulation in Patients with Infections
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- Seki Yoshinobu
- Department of Internal Medicine, Shibata Hospital-Niigata Prefectural Hospital, Japan
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- Wada Hideo
- Department of Molecular and Laboratory Medicine, Mie University School of Medicine, Japan
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- Kawasugi Kazuo
- Department of Internal Medicine, Teikyo University School of Medicine, Japan
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- Okamoto Kohji
- The First Department of of Surgery, University of Occupational and Environmental Health School of Medicine, Japan
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- Uchiyama Toshimasa
- Department of Internal Medicine, National Hospital Organization Takasaki General Medical Center, Japan
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- Kushimoto Shigeki
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Japan
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- Hatada Tsuyoshi
- Emergency Critical Care Center, Mie University Hospital, Japan
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- Matsumoto Takashi
- Division of Blood Transfusion, Mie University Graduate School of Medicine, Japan
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- Imai Hiroshi
- Emergency Critical Care Center, Mie University Hospital, Japan
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Abstract
Objective Disseminated intravascular coagulation (DIC) is often associated with infection and a poor outcome. In this study, useful markers for predicting poor outcomes were examined.<br> Methods The frequency of DIC and organ failure, outcomes and hemostatic markers were prospectively evaluated in 242 patients with infections.<br> Results Seventy-seven patients were diagnosed with DIC, 36 of whom recovered from the condition. The rate of DIC or resolution of DIC was highest in the patients with sepsis and lowest in the patients with respiratory infections. Mortality tended to be high in the patients with respiratory infections. The DIC score, sepsis-related organ failure assessment (SOFA) score, prothrombin time (PT) ratio and thrombin-antithrombin complex level were significantly high in the patients who did not recover from DIC. The age, DIC score, SOFA score, PT ratio and levels of thrombomodulin and plasminogen activator inhibitor (PAI)-I were significantly high in the non-survivors. Factors related to a poor outcome included resolution of DIC, the SOFA score, age and the PT ratio. Factors related to resolution of DIC included the SOFA score and age, while factors related to the SOFA score included the levels of PAI-I, leukocytes, fibrinogen, D-dimer and platelets.<br> Conclusion The outcomes of septic patients primarily depend on the SOFA score and the resolution of DIC, which are related to organ failure.<br>
Journal
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- Internal Medicine
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Internal Medicine 52 (17), 1893-1898, 2013
The Japanese Society of Internal Medicine