Disseminated intravascular coagulation (DIC) in ICU: predictors and outcome

Introduction

Signs and symptoms of shock are not only the direct effect of endotoxin and proinflammatory cytokines. When the process progresses to malperfusion and organ failure, activation of the coagulation system comes into play. Early diagnosis and treatment are thus required to improve the clinical management of DIC.

Methods

Fifty patients at high risk of DIC were prospectively evaluated: 19 with sepsis (38%), 13 with septic shock (26%), six with hypovolemic shock (12%), six with cardiogenic shock (12%) and six with polytrauma (12%). Blood samples for measurements of coagulation variables were taken daily for the following 3 days.

Results

DIC independent predictors at admission were: soluble fibrin (SF; OR 1.14, 95% CI 1.01-1.28; P = 0.037); thrombin-antithrombin (TAT; OR 1.06, 95% CI 1.00-1.11; P = 0.046); and antithrombin (AT; OR 0.85, 95% CI 0.74-0.98; P = 0.033). Kaplan-Meier estimates of hospital survival showed significantly higher mortality rates for patients with increasing severity of DIC according to this classification (Table): non-DIC, 0%; mild DIC, 6%; moderate DIC, 32%; and severe DIC, 62% (P = 0.0005).

Table

Conclusion

Low concentrations of AT on admission are the best predictor for DIC. Efforts should be directed to this group of patients to improve outcome. Moderate and severe DIC carry a very high mortality.