Evaluation of modified non-overt DIC criteria on the prediction of poor outcome in patients with sepsis

Oh, D.; Jang, M.J.; Lee, S.J.; Chong, S.Y.; Kang, M.S.; Wada, H.

doi:10.1016/j.thromres.2009.12.008

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Volume 126, Issue 1 , Pages 18-23, July 2010

Evaluation of modified non-overt DIC criteria on the prediction of poor outcome in patients with sepsis

D. Oh
- Department of Internal Medicine, College of Medicine, Pochon CHA University, Sungnam, Korea
- Institute for Clinical Research, College of Medicine, Pochon CHA University, Sungnam, Korea
- Corresponding author. Department of Internal Medicine, College of Medicine, Pochon CHA University, 351 Yatap-dong, Bundang-gu, Sungnam 463-712, Korea. Tel.: +82 31 780 5217; fax: +82 31 780 5208.
M.J. Jang
- Department of Internal Medicine, College of Medicine, Pochon CHA University, Sungnam, Korea
S.J. Lee
- Institute for Clinical Research, College of Medicine, Pochon CHA University, Sungnam, Korea
S.Y. Chong
- Department of Internal Medicine, College of Medicine, Pochon CHA University, Sungnam, Korea
M.S. Kang
- Department of Laboratory Medicine, College of Medicine, Pochon CHA University, Sungnam, Korea
H. Wada
- Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu-city, Japan

Received 25 August 2009; received in revised form 9 November 2009; accepted 2 December 2009. published online 22 February 2010.

Abstract

Background

The diagnostic performance of modified criteria for non-overt disseminated intravascular coagulation (DIC) with the addition of antithrombin (AT) levels, protein C (PC) levels, and organ system failure scoring (OSF) to the International Society on Thrombosis and Hemostasis (ISTH) criteria for non-overt DIC was studied to determine the effect on predicting poor outcome in patients with sepsis.

Methods

In total, 135 consecutive patients were studied. Hemostatic markers (platelet count, prothrombin time, D-dimer, AT, PC) were examined on days 0, 1, 2, 3, 4, and 7. ISTH overt and non-overt DIC scoring, OSF, and 28-day mortality were analyzed.

Results

The numbers of patients with overt DIC, non-overt DIC and non-DIC were 42, 17 and 76 respectively. The 28-day mortality rates for ISTH overt DIC, ISTH non-overt DIC, and non-DIC were 47.6, 47.1, and 9.2%, respectively. By adding AT and PC to the ISTH non-overt DIC criteria, the 28-day mortality rate of overt DIC, non-overt DIC, and non-DIC changed to 47.6, 25.0, and 6.7%, respectively. By adding OSF to the ISTH non-overt DIC criteria to predict 28-day mortality in septic patients, receiver operating characteristic (ROC) curve analysis demonstrated that the area under the curve (AUC) of ISTH non-overt DIC (0.777) was significantly increased to 0.878 (P=0.018). However, neither AT nor PC increased the AUC.