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Thromb Haemost 2021; 121(04): 457-463
DOI: 10.1055/s-0040-1718736
Coagulation and Fibrinolysis

Evaluation of Sepsis-Induced Coagulopathy in Critically Ill Pediatric Patients with Septic Shock

Won Kyoung Jhang
1   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
,
Seong Jong Park 
1   Division of Pediatric Critical Care Medicine, Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
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Abstract

Background Coagulopathy is a common serious complication of sepsis and septic shock; thus, its early detection and prompt management are important. For this purpose, recently the sepsis-induced coagulopathy (SIC) score was proposed.

Methods We modified the SIC score for critically ill children with septic shock and evaluated its performance in comparison to several coagulopathy diagnostic scoring systems.

Results Among 135 included patients, a significant number of patients were diagnosed with coagulopathy using different coagulopathy diagnostic criteria (up to 84.4% using the SIC score). The modified SIC score, comprising the pediatric sequential organ failure assessment (pSOFA) score, prothrombin time, and D-dimer, was used to diagnose SIC in 68 (50.4%) patients. It was well correlated with the pSOFA score and the International Society on Thrombosis and Haemostasis disseminated intravascular coagulation (DIC) score, as well as the SIC score (p < 0.001). The overall 28-day mortality rate was 18.7%. Patients with coagulopathy had worse clinical outcomes compared to those without coagulopathy. The modified SIC score was identified as an independent prognostic factor for 28-day mortality. The area under the receiver operating characteristic curve for performance of the modified SIC score to predict 28-day mortality evaluated was 0.771 (95% confidence interval: 0.658–0.883), better than those of the SIC and ISTH DIC scores (p < 0.05).

Conclusion Critically ill pediatric patients with septic shock frequently had concomitant coagulopathy. The modified SIC score showed good ability to predict 28-day mortality, suggesting its potential as a prognostic factor in these critically ill pediatric patients.

Keywords

critically ill - disseminated intravascular coagulation - intensive care unit - pediatric - sepsis-induced coagulopathy - septic shock


Publication History

Received: 19 August 2020

Accepted: 14 September 2020

Article published online:
29 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Levi M, van der Poll T. Coagulation and sepsis. Thromb Res 2017; 149: 38-44
    CrossrefPubMedSearch in Google Scholar
  • 2 Simmons J, Pittet J-F. The coagulopathy of acute sepsis. Curr Opin Anaesthesiol 2015; 28 (02) 227-236
    CrossrefPubMedSearch in Google Scholar
  • 3 Semeraro N, Ammollo CT, Semeraro F, Colucci M. Coagulopathy of acute sepsis. Semin Thromb Hemost 2015; 41 (06) 650-658
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Okamoto K, Tamura T, Sawatsubashi Y. Sepsis and disseminated intravascular coagulation. J Intensive Care 2016; 4: 23
    CrossrefPubMedSearch in Google Scholar
  • 5 Iba T, Levy JH, Raj A, Warkentin TE. Advance in the management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Clin Med 2019; 8 (05) E728
    CrossrefPubMedSearch in Google Scholar
  • 6 Gando S. Microvascular thrombosis and multiple organ dysfunction syndrome. Crit Care Med 2010; 38 (2, Suppl): S35-S42
    CrossrefPubMedSearch in Google Scholar
  • 7 Lyons PG, Micek ST, Hampton N, Kollef MH. Sepsis-associated coagulopathy severity predicts hospital mortality. Crit Care Med 2018; 46 (05) 736-742
    CrossrefPubMedSearch in Google Scholar
  • 8 Jhang WK, Ha E, Park SJ. Evaluation of disseminated intravascular coagulation scores in critically ill pediatric patients with septic shock. J Crit Care 2018; 47: 104-108
    CrossrefPubMedSearch in Google Scholar
  • 9 Khemani RG, Bart RD, Alonzo TA, Hatzakis G, Hallam D, Newth CJ. Disseminated intravascular coagulation score is associated with mortality for children with shock. Intensive Care Med 2009; 35 (02) 327-333
    CrossrefPubMedSearch in Google Scholar
  • 10 Iba T, Nisio MD, Levy JH, Kitamura N, Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ Open 2017; 7 (09) e017046
    CrossrefPubMedSearch in Google Scholar
  • 11 Singer M, Deutschman CS, Seymour CW. et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315 (08) 801-810
    CrossrefPubMedSearch in Google Scholar
  • 12 Iba T, Arakawa M, Di Nisio M. et al. Newly proposed sepsis-induced coagulopathy precedes International Society on Thrombosis and Haemostasis overt-disseminated intravascular coagulation and predicts high mortality. J Intensive Care Med 2020; 35 (07) 643-649
    CrossrefPubMedSearch in Google Scholar
  • 13 Iba T, Arakawa M, Levy JH. et al. Sepsis-induced coagulopathy and Japanese Association for Acute Medicine DIC in coagulopathic patients with decreased antithrombin and treated by antithrombin. Clin Appl Thromb Hemost 2018; 24 (07) 1020-1026
    CrossrefPubMedSearch in Google Scholar
  • 14 Iba T, Levy JH, Warkentin TE, Thachil J, van der Poll T, Levi M. Scientific and Standardization Committee on DIC, and the Scientific and Standardization Committee on Perioperative and Critical Care of the International Society on Thrombosis and Haemostasis. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost 2019; 17 (11) 1989-1994
    CrossrefPubMedSearch in Google Scholar
  • 15 Yamakawa K, Yoshimura J, Ito T, Hayakawa M, Hamasaki T, Fujimi S. External validation of the two newly proposed criteria for assessing coagulopathy in sepsis. Thromb Haemost 2019; 119 (02) 203-212
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Ding R, Wang Z, Lin Y, Liu B, Zhang Z, Ma X. Comparison of a new criteria for sepsis-induced coagulopathy and International Society on Thrombosis and Haemostasis disseminated intravascular coagulation score in critically ill patients with sepsis 3.0: a retrospective study. Blood Coagul Fibrinolysis 2018; 29 (06) 551-558
    CrossrefPubMedSearch in Google Scholar
  • 17 Taylor Jr FB, Toh CH, Hoots WK, Wada H, Levi M. Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86 (05) 1327-1330
    Thieme ConnectPubMedSearch in Google Scholar
  • 18 Matics TJ, Sanchez-Pinto LN. Adaptation and validation of a pediatric sequential organ failure assessment score and evaluation of the Sepsis-3 definitions in critically ill children. JAMA Pediatr 2017; 171 (10) e172352
    CrossrefPubMedSearch in Google Scholar
  • 19 Brilli RJ, Goldstein B. Pediatric sepsis definitions: past, present, and future. Pediatr Crit Care Med 2005; 6 (3, Suppl): S6-S8
    CrossrefPubMedSearch in Google Scholar
  • 20 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
    CrossrefPubMedSearch in Google Scholar
  • 21 DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988; 44 (03) 837-845
    CrossrefPubMedSearch in Google Scholar
  • 22 Hayakawa M, Saito S, Uchino S. et al. Characteristics, treatments, and outcomes of severe sepsis of 3195 ICU-treated adult patients throughout Japan during 2011-2013. J Intensive Care 2016; 4: 44
    CrossrefPubMedSearch in Google Scholar
  • 23 Ha SO, Park SH, Hong SB, Jang S. Performance evaluation of five different disseminated intravascular coagulation (DIC) diagnostic criteria for predicting mortality in patients with complicated sepsis. J Korean Med Sci 2016; 31 (11) 1838-1845
    CrossrefPubMedSearch in Google Scholar
  • 24 Kobayashi N, Maekawa T, Takada M, Tanaka H, Gonmori H. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibl Haematol 1983; (49) 265-275
    PubMedSearch in Google Scholar
  • 25 Kaneko T, Wada H. Diagnostic criteria and laboratory tests for disseminated intravascular coagulation. J Clin Exp Hematop 2011; 51 (02) 67-76
    CrossrefPubMedSearch in Google Scholar
  • 26 Wada H, Thachil J, Di Nisio M. et al. The Scientific Standardization Committee on DIC of the International Society on Thrombosis Haemostasis. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost 2013
    Search in Google Scholar
  • 27 Song J, Hu D, He C. et al. Novel biomarkers for early prediction of sepsis-induced disseminated intravascular coagulation in a mouse cecal ligation and puncture model. J Inflamm (Lond) 2013; 10 (01) 7
    CrossrefPubMedSearch in Google Scholar
  • 28 Iba T, Ito T, Maruyama I. et al. Potential diagnostic markers for disseminated intravascular coagulation of sepsis. Blood Rev 2016; 30 (02) 149-155
    CrossrefPubMedSearch in Google Scholar
  • 29 Gando S, Iba T, Eguchi Y. et al. Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med 2006; 34 (03) 625-631
    CrossrefPubMedSearch in Google Scholar
  • 30 Levi M, Meijers JC. DIC: which laboratory tests are most useful. Blood Rev 2011; 25 (01) 33-37
    CrossrefPubMedSearch in Google Scholar
  • 31 Di Nisio M, Baudo F, Cosmi B. et al. Italian Society for Thrombosis and Haemostasis. Diagnosis and treatment of disseminated intravascular coagulation: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res 2012; 129 (05) e177-e184
    CrossrefPubMedSearch in Google Scholar
  • 32 Lee DH, Lee BK, Jeung KW. et al. Performance of 5 disseminated intravascular coagulation score systems in predicting mortality in patients with severe trauma. Medicine (Baltimore) 2018; 97 (33) e11912
    CrossrefPubMedSearch in Google Scholar
  • 33 Asakura H, Takahashi H, Uchiyama T. et al. DIC subcommittee of the Japanese Society on Thrombosis and Hemostasis. Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thromb J 2016; 14: 42
    CrossrefPubMedSearch in Google Scholar
  • 34 Wada H, Matsumoto T, Yamashita Y, Hatada T. Disseminated intravascular coagulation: testing and diagnosis. Clin Chim Acta 2014; 436: 130-134
    CrossrefPubMedSearch in Google Scholar
  • 35 Asakura H. Classifying types of disseminated intravascular coagulation: clinical and animal models. J Intensive Care 2014; 2 (01) 20
    CrossrefPubMedSearch in Google Scholar
  • 36 Iba T, Watanabe E, Umemura Y. et al. Japanese Surviving Sepsis Campaign Guideline Working Group for disseminated intravascular coagulation. Sepsis-associated disseminated intravascular coagulation and its differential diagnoses. J Intensive Care 2019; 7: 32
    CrossrefPubMedSearch in Google Scholar
  • 37 Iba T, Levy JH, Wada H, Thachil J, Warkentin TE, Levi M. Subcommittee on Disseminated Intravascular Coagulation. Differential diagnoses for sepsis-induced disseminated intravascular coagulation: communication from the SSC of the ISTH. J Thromb Haemost 2019; 17 (02) 415-419
    CrossrefPubMedSearch in Google Scholar
  • 38 Sivula M, Pettilä V, Niemi TT, Varpula M, Kuitunen AH. Thromboelastometry in patients with severe sepsis and disseminated intravascular coagulation. Blood Coagul Fibrinolysis 2009; 20 (06) 419-426
    CrossrefPubMedSearch in Google Scholar
  • 39 Sharma A, Sikka M, Gomber S, Sharma S. Plasma fibrinogen and D-dimer in children with sepsis: a single-center experience. Iran J Pathol 2018; 13 (02) 272-275
    Search in Google Scholar
  • 40 Yu M, Nardella A, Pechet L. Screening tests of disseminated intravascular coagulation: guidelines for rapid and specific laboratory diagnosis. Crit Care Med 2000; 28 (06) 1777-1780
    CrossrefPubMedSearch in Google Scholar
  • 41 Gando S, Saitoh D, Ogura H. et al. Japanese Association for Acute Medicine Sepsis Registry Study Group. A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis. Crit Care 2013; 17 (03) R111
    CrossrefPubMedSearch in Google Scholar