Role of disseminated intravascular coagulation in severe sepsis.

Aged Aged, 80 and over Disseminated Intravascular Coagulation / blood Female Humans Male Middle Aged Prospective Studies Retrospective Studies Sepsis / blood

Disseminated intravascular coagulation (DIC) Organ dysfunction Outcome Sepsis Septic shock Severe sepsis

Journal

Thrombosis research

ISSN: 1879-2472

Titre abrégé: Thromb Res

Pays: United States

ID NLM: 0326377

Informations de publication

Date de publication:
Jun 2019

Historique:

received: 20 01 2019

revised: 23 03 2019

accepted: 23 04 2019

pubmed: 6 5 2019

medline: 3 3 2020

entrez: 5 5 2019

Statut: ppublish

Résumé

Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.

Sections du résumé

BACKGROUND BACKGROUND

Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis.

OBJECTIVES OBJECTIVE

We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis.

METHODS METHODS

Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes.

RESULTS RESULTS

The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability.

CONCLUSIONS CONCLUSIONS

The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.

Identifiants

DOI: 10.1016/j.thromres.2019.04.025 PMID: 31054468

pubmed: 31054468

pii: S0049-3848(19)30218-X

doi: 10.1016/j.thromres.2019.04.025

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

182-188

Investigateurs

Osamu Tasaki (O)

Yasumitsu Mizobata (Y)

Hiraku Funakoshi (H)

Toshiro Okuyama (T)

Iwao Yamashita (I)

Toshio Kanai (T)

Yasuo Yamada (Y)

Mayuki Aibiki (M)

Keiji Sato (K)

Susumu Yamashita (S)

Kenichi Yoshida (K)

Shunji Kasaoka (S)

Akihide Kon (A)

Hiroshi Rinka (H)

Hiroshi Kato (H)

Hiroshi Okudera (H)

Eichi Narimatsu (E)

Toshifumi Fujiwara (T)

Manabu Sugita (M)

Yasuo Shichinohe (Y)

Hajime Nakae (H)

Ryouji Iiduka (R)

Yuji Murata (Y)

Mitsunobu Nakamura (M)

Yoshitake Sato (Y)

Hiroyasu Ishikura (H)

Yasuhiro Myojo (Y)

Yasuyuki Tsujita (Y)

Kosaku Kinoshita (K)

Hiroyuki Yamaguchi (H)

Toshihiro Sakurai (T)

Satoru Miyatake (S)

Takao Saotome (T)

Susumu Yasuda (S)

Toshikazu Abe (T)

Hiroshi Ogura (H)

Yutaka Umemura (Y)

Atsushi Shiraishi (A)

Shigeki Kushimoto (S)

Daizoh Saitoh (D)

Seitaro Fujishima (S)

Junichi Sasaki (J)

Toshihiko Mayumi (T)

Yasukazu Shiino (Y)

Taka-Aki Nakada (TA)

Takehiko Tarui (T)

Toru Hifumi (T)

Yasuhiro Otomo (Y)

Joji Kotani (J)

Yuichiro Sakamoto (Y)

Shin-Ichiro Shiraishi (SI)

Kiyotsugu Takuma (K)

Ryosuke Tsuruta (R)

Akiyoshi Hagiwara (A)

Kazuma Yamakawa (K)

Naoshi Takeyama (N)

Norio Yamashita (N)

Hiroto Ikeda (H)

Yasuaki Mizushima (Y)

Satoshi Gando (S)