Disseminated Intravascular Coagulation in Sepsis is Associated with Specific Infection and Organ Dysfunction

Yao-Wen Kuo ； Kuei-Pin Chung ； Hou-Tai Chang ； Chong-Jen Yu

《胸腔醫學》 36卷2期 (2021/06) Pp. 95-105

摘要

Introduction: The failure of randomized controlled trials to demonstrate the efficacy of treatments targeting disseminated intravascular coagulation (DIC) in sepsis may imply that DIC develops under specific clinical contexts in patients with sepsis. However, the clinical features associated with DIC development in sepsis are not well understood yet. Methods: We conducted a prospective study and enrolled 126 patients with sepsis admitted to medical intensive care units (ICUs) in 2 medical centers. DIC was determined based on the Japanese Association for Acute Medicine (JAAM) or the International Society on Thrombosis and Haemostasis (ISTH) scoring systems. Results: Using the JAAM score, we identified 39 patients (31%) with DIC at ICU admission. Multivariate analysis indicated that clinical features significantly associated with increased risk of JAAM DIC included hypotension (odds ratio [OR] 8.037, 95% confidence interval [CI] 1.496-43.175, P= 0.015) and infections other than pneumonia, particularly intra-abdominal infections (OR 8.952, 95% CI 1.765-43.395, P= 0.008). Meanwhile, 10 patients (7.9%) were diagnosed with overt DIC according to the ISTH score, and multivariate analysis indicated that congestive heart failure (OR 9.192, 95% CI 1.665-50.761, P = 0.011) and hyperbilirubinemia (OR 6.525, 95% CI 1.311-32.481, P= 0.022) were significantly associated with increased risk of overt DIC. Conclusion: Our results suggest that, rather than being a common phenomenon in sepsis, DIC may be a unique complication under certain clinical conditions. The exact mechanisms that explain the association between these clinical features and DIC are unknown, and warrant further investigation.

關鍵字

critical illness ； coagulation ； sepsis ； septic shock ； outcome