- Poster presentation
- Published:
Disseminated intravascular coagulation score predicts mortality in critically ill patients with liver cirrhosis
Critical Care volume 19, Article number: P377 (2015)
Introduction
The disseminated intravascular coagulation (DIC) score is a predictor of outcome in critically ill patients [1, 2]. Yet disturbances of coagulation and hemostasis, as reflected by the DIC score, are a common finding in patients with liver cirrhosis. Thus, it is unclear whether the DIC score has prognostic value in critically ill patients with liver cirrhosis. The aim of this study was to assess the applicability and prognostic impact of the DIC score in critically ill patients with liver cirrhosis.
Methods
Patients with liver cirrhosis admitted to the medical ICU were analyzed for this study. Detailed laboratory analyses including platelet count, D-dimer, fibrinogen and prothrombin index were performed on admission and the DIC score was calculated. Survival was assessed on site or by contacting the patients or the attending physician.
Results
In total, 150 admissions to the ICU with liver cirrhosis were analyzed. Thirty-nine percent were female. Median age was 56 (IQR 49 to 63) years. The median SOFA score on admission was 9 (6 to 13), median MELD score 26 (IQR 18 to 36). Twenty-eight-day mortality was 59%. Median DIC score on admission was 5 (IQR 4 to 6). Overt DIC (DIC score ≥5) was found in 65%. DIC score was significantly higher in nonsurvivors compared with survivors (5 (IQR 4 to 7) vs. 4 (IQR 3 to 6); P < 0.01). AUROC for the DIC score in prediction of 28-day mortality was 0.68 (95% CI = 0.59 to 0.77). Overt DIC on admission was significantly associated with 28-day mortality (OR = 3.4 (95% CI = 1.69 to 6.84), P < 0.01). The 28-day mortality rate in admissions with cirrhosis and overt DIC was 70% compared with 40% in those with a DIC score <5.
Conclusion
Disturbances in coagulation and hemostasis are found in the majority of cirrhotic patients admitted to the ICU. The DIC score is a suitable predictor of 28-day mortality in critically ill patients with liver cirrhosis.
References
Taylor FB, Toh CH, Hoots WK, Wada H, Levi M: Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH) Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001, 1327-30. 86:
Angstwurm MWA, Dempfle C-E, Spannagl M: New disseminated intravascular coagulation score: a useful tool to predict mortality in comparison with Acute Physiology and Chronic Health Evaluation II and Logistic Organ Dysfunction scores. Crit Care Me. 2006, 314-20; quiz 328. 34
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Drolz, A., Horvatits, T., Rutter, K. et al. Disseminated intravascular coagulation score predicts mortality in critically ill patients with liver cirrhosis. Crit Care 19 (Suppl 1), P377 (2015). https://doi.org/10.1186/cc14457
Published:
DOI: https://doi.org/10.1186/cc14457