Outcome of Disseminated Intravascular Coagulation in Relation to the Score when Treatment was Begun

Abstract

SummaryWe examined 395 patients with disseminated intravascular coagulation (DIC) divided into two groups: non-leukemic and leukemic. In 58% of the patients as a whole, treatment of DIC resulted in complete or partial remission, while exacerbation and death occurred in 31%. The efficacy of DIC treatment in the non-leukemic group was less than that in the leukemic group, indicating that the outcome of DIC depended, in part, on the underlying disease. We examined hemostatic indicators in relation to DIC score: prothrombin time (PT) ratio, FDP, platelet count, and fibrinogen levels were found to be important indicators for the diagnosis of DIC, but not for Pre-DIC. Plasma levels of fibrin-D-dimer, thrombin-antithrombin complex (TAT), and plasmin- plasmin inhibitor complex (PPIC) were significantly increased in pre-DIC. The efficacy of treatment in relation to the DIC score when the treatment was begun showed that greater efficacy was achieved in pre-DIC than in DIC patients. The outcome was poorer with increasing DIC score, suggesting that early diagnosis and early treatment are important. On examining the relationship between outcome and hemostatic indicators, we found that the PT ratio and the levels of antithrombin, plasminogen, PPIC, the PPIC/TAT ratio, and thrombomodulin were related to outcome, suggesting that very high consumption of blood coagulation factors, liver dysfunction, hypofibrinolysis, or organ failure caused a poor outcome. Although the outcome in DIC patients may not depend substantially on plasma levels of TAT and fibrin-D- dimer, we can use these indicators to treat DIC patients at an early stage.

Modified non‐overt DIC diagnostic criteria predict the early phase of overt‐DIC

“…The mortality of the late onset DIC was similar to that of pre-DIC. A previous report [8] also showed that outcome was improved by early DIC treatment. At present, no diagnostic criteria have yet been established for pre-DIC, and we therefore recommend that the treatment of DIC in non-overt-DIC positive should be started as early as possible in patients who are DIC absent but are positive for our modified non-overt DIC criteria.…”

“…The treatment efficacy in relation to the JMHW DIC score at the beginning of treatment showed that a greater efficacy was achieved in pre-DIC patients than in DIC patients [8]. The patient prognosis was progressively worse with increasing DIC score, suggesting that early diagnosis and early treatment are essential for improving the patient outcome.…”

“…The frequency of DIC in patients with severe sepsis was 40.7% according to the KyberSept trial results (antithrombin; AT) [5] and 22.4% in the PROWESS study (recombinant activated protein C; APC) [6]. The patients with severe sepsis have a poor prognosis and the septic patients who also have DIC have an even worse outcome.The treatment efficacy in relation to the JMHW DIC score at the beginning of treatment showed that a greater efficacy was achieved in pre-DIC patients than in DIC patients [8]. The patient prognosis was progressively worse with increasing DIC score, suggesting that early diagnosis and early treatment are essential for improving the patient outcome.…”

Hemostatic markers and the sepsis‐related organ failure assessment score in patients with disseminated intravascular coagulation in an intensive care unit

“…The cutoff values of fibrin-related markers should be determined in overt-DIC criteria of ISTH. Early diagnosis and treatment of DIC were reported to be important to improve outcomes in DIC [24]. Among hemostatic molecular markers, plasma levels of D-dimer, TAT, PPIC, SF, tPA-PAI-I complex, and TM were significantly increased and plasma AT levels were significantly decreased in patients with DIC diagnosed by both ISTH and JMHW criteria.…”

“…This study comprised 1,789 patients admitted to the ICU of the Mie University School of Medicine from January 1998 through December 2001. Underlying conditions included post-operative patients (n ¼ 1,055), trauma (n ¼ 241), sepsis (n ¼ 73), heart disease (380), respiratory disease (299), aortic disease (183), cerebral disease (115), hepatic disease (24), and other diseases (547). Of the 1,789 patients, 127 (7.1%) died.…”