Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria - Comparison between sepsis and trauma
Shigeki Kushimoto 1; Satoshi Gando 2; Daizoh Saitoh 3; Hiroshi Ogura 4; Toshihiko Mayumi 5; Kazuhide Koseki 6; Toshiaki Ikeda 7; Hiroyasu Ishikura 8; Toshiaki Iba 9; Masashi Ueyama 10; Yutaka Eguchi 11; Yasuhiro Otomo 12; Kohji Okamoto 13; Shigeatsu Endo 14; Shuji Shimazaki 15; the Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group
1 Department of Emergency and Critical Care Medicine, Nippon Medical School – Tokyo Japan; 2 Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo Japan; 3 Division of Traumatology, National Defense Medical College Research Institute, National Defense Medical College, Tokorozaura Japan; 4 Department of Traumatology and Acute Critical Care Medicine, Osaka University Medical School, Osaka Japan; 5 Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya Japan; 6 Emergency and Critical Care Medicine, Kawaguchi Municipal Medical Center, Kawaguchi Japan; 7 Department of Critical Care and Emergency Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo Japan; 8 Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka Japan; 9 Department of Emergency Medicine, Juntendo University, Tokyo Japan; 10 Department of Traumatology, Critical Care Medicine and Burn Center, Social Insurance Chukyo Hospital, Nagoya Japan; 11 Critical and Intensive Care Medicine, Shiga University of Medical Science, Otsu Japan; 12 Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo Japan; 13 Department of Surgery 1, School of Medicine, University of Occupational and Environmental Health, Kitakyushu Japan; 14 Department of Critical Care Medicine, School of Medicine, Iwate Medical University, Morioka Japan; 15 Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Tokyo, Japan
Diagnosis, Trauma, sepsis, disseminated intravascular coagulation, criteria
The Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH).Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n=98) or trauma (n=95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p<0.0001).Within three days of fulfilling the JAAM criteria, sepsis patients had a lower platelet count, higher prothrombin time ratio, higher systemic inflammatory response syndrome score, and higher Sequential Organ Failure Assessment score compared with trauma patients. On day 3, a significantly higher percentage of trauma patients than sepsis patients showed improvement of DIC (64.2% vs. 30.6%, p<0.001).These differences were mainly due to patients with lower JAAM DIC scores. More than 50% of the JAAM DIC patients with sepsis who died within 28 days could not be detected by ISTH DIC criteria during the initial three days. In contrast, most trauma patients who died within 28 days had DIC simultaneously diagnosed by JAAM and ISTH criteria, except for those with brain death.These findings suggest that coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.