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Thromb Haemost 2024; 124(05): 399-407
DOI: 10.1055/a-2196-3630
Coagulation and Fibrinolysis

Persistent and Late-Onset Disseminated Intravascular Coagulation Are Closely Related to Poor Prognosis in Patients with Sepsis

Tadashi Matsuoka
1   Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
,
Kazuma Yamakawa 
2   Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
,
Toshiaki Iba 
3   Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
,
Koichiro Homma
1   Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
,
Junichi Sasaki
1   Department of Emergency and Critical Care Medicine, School of Medicine, Keio University, Tokyo, Japan
› Author Affiliations Funding This work was supported by JSTH research grant program for DIC with acute illness (Grant #2023–001) and JSPS KAKENHI (Grant #22K16630).
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Abstract

Background Septic-associated disseminated intravascular coagulation (DIC) is heterogeneous regarding prognosis and responsiveness to anticoagulant therapy.

Objectives To investigate the relationship between the timing of development and recovery of DIC, its prognosis, and the difference in response to anticoagulant therapy in sepsis-associated DIC patients.

Methods This study was performed with a dataset from a multicenter nationwide retrospective cohort study (J-Septic DIC registry) in Japan between 2011 and 2013 to reveal the subgroup “high risk of death in DIC” and investigate the relationship between anticoagulant use and mortality. Patients were assigned to four groups based on the International Society on Thrombosis and Haemostasis-overt DIC status at days 1 and 3: non-DIC (−/−), early-recovered DIC (+/−), late-onset DIC (−/+), and persistent DIC (+/+).

Results A total of 1,922 patients were included. In-hospital mortality in persistent and late-onset DIC patients was significantly higher than in patients with non-DIC and early-recovered DIC. This finding indicates that persistent DIC and late-onset DIC were a poor-prognosis subgroup, “high-risk” DIC. Meanwhile, patients with high-risk DIC treated with anticoagulants had significantly better outcomes than those without anticoagulants after adjusting for confounding factors.

Conclusion This study showed that individuals with a high risk of death, persistent DIC, and late-onset DIC were a poor-prognostic subgroup in septic DIC; however, high-risk DIC is also a subgroup that can obtain more benefits from anticoagulant therapy.

Keywords

disseminated intravascular coagulation - sepsis - anticoagulant therapy

Supplementary Material



Publication History

Received: 12 July 2023

Accepted: 21 October 2023

Accepted Manuscript online:
23 October 2023

Article published online:
21 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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