Korean J Crit Care Med.  2016 Nov;31(4):334-341. 10.4266/kjccm.2016.00339.

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

• Ko BS
• Cho HY
• Ryoo SM
• Kim MC
• Jung W
• Park SH
• Lee CM
• Kim WY

• KMID: 2371189
• DOI: http://doi.org/10.4266/kjccm.2016.00339

Abstract

BACKGROUND
The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock.
METHODS
We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality.
RESULTS
Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]).
CONCLUSIONS
Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Keyword

disseminated intravascular coagulation; prevalence; shock, septic

MeSH Terms

Arterial Pressure
Consensus*
Dacarbazine
Disseminated Intravascular Coagulation*
Emergencies*
Emergency Service, Hospital*
Hemostasis
Humans
Hypotension
Lactic Acid
Logistic Models
Mortality
Prevalence*
Retrospective Studies
Shock, Septic*
Survivors
Tertiary Healthcare
Thrombosis
Dacarbazine
Lactic Acid

Figure

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  Fig. 1. Patient flow diagram. ED: emergency department; DIC: disseminated intravascular coagulation.

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  Fig. 2. Patient number according to ISTH score. ISTH: international society of thrombosis and hemostasis.

Reference

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