Flæng Simon, Granfeldt Asger, Adelborg Kasper, Sørensen Henrik Toft
Department of Clinical Epidemiology and Center for Population Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Infect Dis (Lond). 2025 Jun;57(6):526-534. doi: 10.1080/23744235.2025.2453591. Epub 2025 Jan 22.
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.
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.
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.
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.
严重感染是弥散性血管内凝血（DIC）最常见的潜在疾病。为了更好地了解临床病程，我们研究了感染相关DIC患者的感染类型与短期死亡率之间的关联。
丹麦弥散性血管内凝血（DANDIC）队列中登记的感染相关DIC患者按感染类型分类：肺部感染、腹腔内感染、泌尿生殖系统感染、其他感染、多个感染部位及感染灶不明。采用Kaplan-Meier方法绘制生存曲线并计算30天和90天死亡率；采用逻辑回归计算比值比，作为相对风险的度量，并给出相应的95%置信区间。回归模型对年龄、性别、合并症以及DIC诊断前一周内的手术情况进行了校正。以最常见的感染类型——肺部感染作为参照组。
共有1853例患者发生感染相关DIC。最常见的感染类型为肺部感染（35.1%）、腹腔内感染（25.6%）和泌尿生殖系统感染（12.6%）。30天死亡率在泌尿生殖系统感染患者中为19.7%，在感染灶不明的患者中为55.1%。相对于肺部感染，泌尿生殖系统感染的30天死亡率比值比为0.22（95%置信区间，0.15 - 0.32），其他感染类型为0.57（95%置信区间，0.39 - 0.82），多个感染部位为0.60（95%置信区间，0.36 - 1.00），腹腔内感染为0.73（95%置信区间，0.56 - 0.97），感染灶不明为1.41（95%置信区间，1.02 - 1.95）。
感染相关DIC短期死亡率较高，且因感染类型而异，这表明感染类型是DIC临床病程的重要预测因素。
