Department of Anesthesiology and Critical Medicine, Hokkaido University Graduate School of Medicine, Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Japan.
Emergency and Trauma Center, Kameda Medical Center, Japan.
Thromb Res. 2019 Jun;178:182-188. doi: 10.1016/j.thromres.2019.04.025. Epub 2019 Apr 26.
Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis.
We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis.
Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes.
The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p = 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability.
The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.
弥散性血管内凝血（DIC）与多器官功能障碍综合征（MODS）相关，在严重脓毒症中起着关键作用。
我们进行了一项多中心、前瞻性数据收集研究，并对数据进行回顾性分析，以确认 DIC 在严重脓毒症中的作用。
纳入符合严重脓毒症定义的 ICU 患者，共纳入 1013 例患者。评估 DIC 评分以及严重程度和 MODS 的发展在严重脓毒症诊断日（第 0 天）和第 3 天。主要结局是住院死亡率，次要结局为第 0 天和第 3 天的 MODS。
严重脓毒症的总体死亡率为 21.5%，DIC 的患病率为 50.9%（516/1013）。DIC 患者在第 0 天病情更严重，MODS 的发生率更高（32.0%比 13.1%），死亡率更高（24.8%比 17.5%）。与非 DIC 患者相比，DIC 患者的生存概率也较低（Log rank p=0.028）。经过倾向评分调整潜在混杂因素的逻辑回归分析，确认 DIC 与严重脓毒症患者的 MODS 和医院死亡之间存在显著关联。从第 0 天到第 3 天新发生的 DIC 和持续的 DIC 与 MODS 发生率高和生存概率低有关。
严重脓毒症的死亡率有所改善，但 DIC 仍然与这些患者的不良预后相关。评估 DIC 状态的动态变化可能会提高预测能力。
