Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

Iba, Toshiaki; Umemura, Yutaka; Watanabe, Eizo; Wada, Takeshi; Hayashida, Kei; Kushimoto, Shigeki

doi:10.1002/ams2.411

Cited by 88 publications

(77 citation statements)

References 75 publications

(94 reference statements)

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“…In the case of DIC, many causes can lead to local microvascular injury, triggering extensive activation of the coagulation system and organ dysfunction. Sepsis-induced DIC is the most common type of DIC, and its incidence is 150 times that of TMA [39]. The main laboratory features of sepsisinduced DIC include thrombocytopenia, increased consumption of coagulation factors, and elevated fibrin markers.…”

Section: Recommendation 9: Peripheral Blood Smears Can Help Diagnose mentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Song¹,

Liu

Zhu

et al. 2020

Military Med Res

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Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.

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Section: Recommendation 9: Peripheral Blood Smears Can Help Diagnose mentioning

confidence: 99%

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Song¹,

Liu

Zhu

et al. 2020

Military Med Res

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“…Third, the diagnosis performances of the scores are unequal depending on the underlying disease, like is the presentation of DIC in the different clinical conditions (e.g., thrombotic DIC induced by sepsis versus bleeding DIC induced by hematologic malignancies). Different DIC scores or diagnosis markers might therefore be necessary for diagnosis, depending on the pathophysiological underlying condition [4]. Finally, repeating multiple coagulation tests to screen patients is costly [5].…”

Section: Introductionmentioning

confidence: 99%

Performances of disseminated intravascular coagulation scoring systems in septic shock patients

Helms¹,

Séverac

Merdji

et al. 2020

Ann. Intensive Care

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Background: There is no gold standard to diagnose septic shock-induced disseminated intravascular coagulation (DIC). The objective of our multicenter prospective study was to assess the performances of the different major scoring systems in terms of mortality prediction and DIC diagnosis. The JAAM-DIC 2016 score, the ISTH overt-DIC 2001 score, the associations of sepsis-induced coagulopathy (SIC) score with JAAM-DIC 2016 or ISTH overt-DIC scores were tested in patients within 12 h of their admission in ICU for septic shock (day 1) and at day 2. Results: 582 patients were enrolled in the study. 182/567 (32.1%) were diagnosed with DIC according to ISTH overt-DIC score, and 193/561 (34.4%) according to JAAM-DIC score; 486/577 patients (84.2%) were diagnosed with a coagulopathy according to SIC score. A moderate concordance was observed between ISTH overt-DIC and JAAM-DIC [κ = 0.67 (0.60, 0.73), p < 0.001]. The delay of positivity of the scores for early DIC patients was not different between JAAM-DIC and ISTH overt-DIC scores. Although it was positive earlier, SIC score had worse diagnosis specificity, as 84.2% of the patients with septic shock were diagnosed with "coagulopathy". The specificity of SIC score alone to predict mortality was very low [0.18 (0.15; 0.22)], compared to the ones of JAAM-DIC score [0.71 (0.67; 0.75)], and of ISTH overt-DIC score [0.76 (0.72; 0.80)], p < 0.001. The sensitivity of SIC score to predict mortality was 0.95 [0.89; 0.98], and the ones of JAAM-DIC score and ISTH overt-DIC score were 0.61 [0.50; 0.70] and 0.68 [0.58; 0.77], respectively. There was no benefit in sensitivity and specificity in combining SIC score to JAAM-DIC score or to ISTH overt-DIC score, compared to JAAM-DIC score or ISTH overt-DIC score alone. Conclusions: Our data suggest that the added value of SIC score alone or combined with other scores is limited, and that both JAAM-DIC score and ISTH overt-DIC score can be used in septic shock patients.

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“…These conditions could also influence coagulation-related laboratory parameters and, consequently, the diagnostic accuracy of the DIC diagnostic criteria. 15,26,27 In hemato-oncologic patients, thrombocytopenia is common by various etiologies including hematologic disorders themselves as well as in treatments such as chemotherapy or bone marrow transplantation. Thrombocytopenia is also associated with complications such as transplantation-associated thrombotic microangiopathy and bone marrow suppression as well as sepsis and septic shock.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Disseminated Intravascular Coagulation in Critically Ill Pediatric Hemato-oncology Patients with Septic Shock

Jhang

Park

2020

Thromb Haemost

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Background Disseminated intravascular coagulation (DIC) is a serious complication in septic shock. This study aimed to evaluate DIC and associated clinical outcomes using the International Society on Thrombosis and Hemostasis (ISTH) and modified ISTH overt DIC scores in critically ill pediatric hemato-oncology patients with septic shock. Methods Pediatric hemato-oncology patients with septic shock admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital between January 2013 and February 2020 were included. We modified the ISTH overt DIC score by eliminating the platelet domain and compared the performances of the ISTH and the modified ISTH overt DIC scores in DIC diagnosis and PICU mortality prediction of these patients. Results DIC was diagnosed in 56.4 and 38.5% of patients by ISTH and modified ISTH overt DIC scores, respectively. Patients with DIC showed a higher pediatric risk of mortality (PRISM) III, pediatric sequential organ failure assessment (pSOFA) scores, and PICU mortality than those without DIC (p < 0.05). The modified ISTH overt DIC score was an independent prognostic factor for PICU mortality and showed a larger area under the receiver operating characteristic curve than the ISTH overt DIC score (0.687 vs. 0.695). Addition of the DIC diagnosis improved the performance of PRISM III in predicting PICU mortality. Conclusion Critically ill pediatric hemato-oncology patients with septic shock frequently experience DIC, which was adequately evaluated by both ISTH and modified ISTH overt DIC scores. Considering the characteristics of these patients, the modified ISTH overt DIC score may be a promising prognostic factor for clinical outcomes in these critically ill pediatric patients.

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Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

Cited by 88 publications

References 75 publications

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

Performances of disseminated intravascular coagulation scoring systems in septic shock patients

Evaluation of Disseminated Intravascular Coagulation in Critically Ill Pediatric Hemato-oncology Patients with Septic Shock

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