Outcomes of Overt and Non-Overt Disseminated Intravascular Coagulation Using the Isth Dic Scoring System in Children: A Single-Center Study

Abstract

Background: Several disseminated intravascular coagulation (DIC) scoring systems are used for prognosticating the clinical outcomes of patients with DIC. However, research on children is scarce. This study compared the clinical outcomes of overt and non-overt DIC using the International Society on Thrombosis and Hemostasis (ISTH) DIC scoring system.
 Methods: This retrospective study reviewed data on children aged 1 month to 15 years diagnosed with DIC between 2003 and 2014.
 Results: Of 244 patients, 179 (73.4%) had overt DIC, and 65 (26.6%) had non-overt DIC. The most common causes were infection (84.8%), tissue injury (7%), and malignancies (2.9%). The 28-day case fatality rate was significantly higher for overt than non-overt DIC (76% vs 15.6%; P < 0.001). DIC scores were significantly associated with mortality (R2 = 0.89). Each clinical parameter (platelet count, prothrombin time, and fibrin degradation products) was associated with mortality (P = 0.01). On multivariable analysis, the factors associated with death were platelet counts ≤ 50 000 cells/mm3 (OR, 2.42; 95% CI, 1.08–5.42; P = 0.031); overt DIC score (OR, 7.62; 95% CI, 2.94–19.75; P < 0.001); renal dysfunction (OR, 2.92; 95% CI, 1.34–6.37; P = 0.007); shock (OR, 39.62; 95% CI, 4.99–314.84; P = 0.001); and acute respiratory distress syndrome (OR, 25.90; 95% CI, 3.12–214.80; P = 0.003).
 Conclusions: The 28-day case-fatality rate was significantly higher for patients with overt than non-overt DIC and concordant with ISTH scores. ISTH DIC scores can be used as a clinical predictor for DIC in children.

Rotational Thromboelastometry and Clot Waveform Analysis as Point-of-Care Tests for Diagnosis of Disseminated Intravascular Coagulation in Critically Ill Children in Thailand*

“…DIC is a life-threatening condition that can lead to serious complications in critically ill children, including bleeding, thrombosis, and death. Several studies have demonstrated that ODIC, which is defined by an ISTH-DIC score of greater than or equal to 5, is associated with adverse events and a 28-day mortality rate in both children and adults (3, 4, 21). In 2018, Padungmaneesub et al (4) reported a prevalence of ODIC in the PICU at Chiang Mai University Hospital of about 24%.…”

“…The other debatable predictive factors for bleeding in DIC were the use of heparin and the administration of antithrombin concentrate (35, 36). However, prognostic research in the pediatric population with DIC usually focuses on the risk factors for mortality, rather than hemorrhagic events (21, 37). According to the multivariable logistic regression analysis in this study, Min2 of less than 0.36%/s 2 was the only independent factor that predicted a bleeding event in critically ill children with DIC.…”

Revolution in sepsis: a symptoms-based to a systems-based approach?

“…4 ) [ 46 , 74 , 99 , 163 ]. Clinically, DIC continues to be diagnosed using a scoring system involving PT, platelet count, fibrinogen, and D-dimer levels [ 13 , 167 , 172 ]. However, without evidence of intravascular fibrin deposition, diagnosis may not be DIC and impact on optimal patient treatment.…”