The modified Japanese Association for Acute Medicine disseminated intravascular coagulation diagnostic criteria in sepsis is useful for an indicator of initiating treatment for disseminated intravascular coagulation.

BACKGROUND

Disseminated intravascular coagulation (DIC) is a severe complication of sepsis. Recently, the Japanese Association for Acute Medicine (JAAM) DIC criteria were modified into the JAAM-2-DIC criteria. This study aimed to assess the utility of the JAAM-2 DIC criteria as an indicator for initiating treatment for DIC using a large-scale database.

METHODS

We analyzed data from the Japanese Administrative Claims Database, which covers approximately 18 million patients from 600 hospitals. Adult patients with sepsis, defined by the Sepsis-3 criteria, were included. The relationship between DIC treatment (recombinant thrombomodulin and antithrombin) and survival, and bleeding complications, including the timing of initiation, was evaluated according to the JAAM-2-DIC, ISTH-overt DIC, and sepsis-induced coagulopathy (SIC) criteria.

RESULTS

Among 1903 patients, 415 (22 %) received DIC treatment. At sepsis diagnosis, 673 (35 %), 174 (9 %), and 699 (37 %) patients met the JAAM-2 DIC, ISTH-overt DIC, and SIC criteria, respectively. DIC treatment was associated with improved survival in patients diagnosed with DIC by any criteria but not in those without DIC. In patients without DIC, DIC treatment increased bleeding complications requiring transfusion, whereas this risk was not elevated in patients with DIC. Only the JAAM-2-DIC criteria showed significant effect modification for both efficacy and safety. Initiating DIC treatment based on JAAM-2-DIC criteria most effectively identified patients with a survival benefit.

CONCLUSION

The JAAM-2-DIC criteria effectively identify patients with better survival outcomes and a low risk of bleeding among those receiving DIC treatment. These criteria may serve as a useful indicator for starting DIC treatment in this population.