Infection type and short-term mortality in patients with infection-associated disseminated intravascular coagulation: a cohort study.

BACKGROUND

Severe infection is the most frequent disease underlying disseminated intravascular coagulation (DIC). To improve understanding of the clinical course, we examined the association between infection type and short-term mortality in patients with infection-associated DIC.

METHODS

Patients with infection-associated DIC registered in the Danish Disseminated Intravascular Coagulation (DANDIC) cohort were categorised by infection type: pulmonary, intra-abdominal, urogenital, others, multiple infection sites and unknown foci. The Kaplan-Meier method was used to create survival curves and compute 30-day and 90-day mortality; logistic regression was used to compute odds ratios, as a measure of relative risk, with corresponding 95% confidence intervals. Regression models were adjusted for age, sex, comorbidities and surgery within one week before DIC diagnosis. Pulmonary infection, the most frequent infection type, was used as the reference group.

RESULTS

In total, 1,853 patients had infection-associated DIC. The most common types of infection were pulmonary (35.1%), intra-abdominal (25.6%) and urogenital (12.6%). Thirty-day mortality ranged from 19.7% in patients with urogenital infections to 55.1% in patients with unknown foci. The 30-day mortality odds ratio with respect to pulmonary infection was 0.22 (95% CI, 0.15-0.32) for urogenital infection, 0.57 (95% CI, 0.39-0.82) for other infection types, 0.60 (95% CI, 0.36-1.00) for multiple infection sites, 0.73 (95% CI, 0.56-0.97) for intra-abdominal infections and 1.41 (95% CI, 1.02-1.95) for unknown foci.

CONCLUSION

Infection-associated DIC had a high short-term mortality, which varied among infection types, thus suggesting that infection type is an important predictor of the clinical course of DIC.