Role of disseminated intravascular coagulation in severe sepsis

Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. 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: 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: 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.

Original languageEnglish
Pages (from-to)182-188
Number of pages7
JournalThrombosis Research
Volume178
DOIs
Publication statusPublished - 2019 Jun 1

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Disseminated Intravascular Coagulation
Sepsis
Multiple Organ Failure
Mortality
Propensity Score
Survival
Hospital Mortality
Logistic Models
Regression Analysis

Keywords

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

ASJC Scopus subject areas

  • Hematology

Cite this

Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group (2019). Role of disseminated intravascular coagulation in severe sepsis. Thrombosis Research, 178, 182-188. https://doi.org/10.1016/j.thromres.2019.04.025

Role of disseminated intravascular coagulation in severe sepsis. / Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group.

In: Thrombosis Research, Vol. 178, 01.06.2019, p. 182-188.

Research output: Contribution to journalArticle

Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group 2019, 'Role of disseminated intravascular coagulation in severe sepsis', Thrombosis Research, vol. 178, pp. 182-188. https://doi.org/10.1016/j.thromres.2019.04.025
Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group. Role of disseminated intravascular coagulation in severe sepsis. Thrombosis Research. 2019 Jun 1;178:182-188. https://doi.org/10.1016/j.thromres.2019.04.025
Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group. / Role of disseminated intravascular coagulation in severe sepsis. In: Thrombosis Research. 2019 ; Vol. 178. pp. 182-188.
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T1 - Role of disseminated intravascular coagulation in severe sepsis

AU - Japanese Association for Acute Medicine (JAAM) Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) Study Group

AU - Gando, Satoshi

AU - Shiraishi, Atsushi

AU - Yamakawa, Kazuma

AU - Ogura, Hiroshi

AU - Saitoh, Daizoh

AU - Fujishima, Seitaro

AU - Mayumi, Toshihiko

AU - Kushimoto, Shigeki

AU - Abe, Toshikazu

AU - Shiino, Yasukazu

AU - Nakada, Taka aki

AU - Tarui, Takehiko

AU - Hifumi, Toru

AU - Otomo, Yasuhiro

AU - Okamoto, Kohji

AU - Umemura, Yutaka

AU - Kotani, Joji

AU - Sakamoto, Yuichiro

AU - Sasaki, Junichi

AU - Shiraishi, Shin ichiro

AU - Takuma, Kiyotsugu

AU - Tsuruta, Ryosuke

AU - Hagiwara, Akiyoshi

AU - Masuno, Tomohiko

AU - Takeyama, Naoshi

AU - Yamashita, Norio

AU - Ikeda, Hiroto

AU - Ueyama, Masashi

AU - Fujimi, Satoshi

AU - Tasaki, Osamu

AU - Mizobata, Yasumitsu

AU - Funakoshi, Hiraku

AU - Okuyama, Toshiro

AU - Yamashita, Iwao

AU - Kanai, Toshio

AU - Yamada, Yasuo

AU - Aibiki, Mayuki

AU - Sato, Keiji

AU - Yamashita, Susumu

AU - Yoshida, Kenichi

AU - Kasaoka, Shunji

AU - Kon, Akihide

AU - Rinka, Hiroshi

AU - Kato, Hiroshi

AU - Okudera, Hiroshi

AU - Narimatsu, Eichi

AU - Fujiwara, Toshifumi

AU - Sugita, Manabu

AU - Shichinohe, Yasuo

AU - Nakae, Hajime

PY - 2019/6/1

Y1 - 2019/6/1

N2 - Background: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. 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: 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: 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.

AB - Background: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. 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: 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: 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.

KW - Disseminated intravascular coagulation (DIC)

KW - Organ dysfunction

KW - Outcome

KW - Sepsis

KW - Septic shock

KW - Severe sepsis

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