Sepsis-Induced Coagulopathy and Japanese Association for Acute Medicine DIC in Coagulopathic Patients with Decreased Antithrombin and Treated by Antithrombin

Abstract

Disseminated intravascular coagulation (DIC) in patients with sepsis represents a critical condition. Thus, a simple and rapid diagnosis is required. The purpose of this study was to compare the performances of a recently developed Sepsis-Induced Coagulopathy (SIC) with the Japanese Association for Acute Medicine (JAAM) DIC. Four hundred nine patients with sepsis having coagulopathy and antithrombin activity of less than 70% and treated with antithrombin were retrospectively analyzed, and the SIC and JAAM-DIC criteria on days 1 (before treatment), 2, 4, and 7 were compared. The prevalence of JAAM-DIC on day 1 was significantly higher than that of SIC (91.4% vs 81.8%, P = .003), but there were no differences on days 2, 4, and 7. The mortality rates in the SIC and JAAM-DIC groups were both 23.3%. The specificity to 28-day mortality on day 1 was higher in the SIC group (15.8% vs 9.2%, P = .013). There were no differences in sensitivity on days 1, 2, 4, and 7. Mortality was significantly different between SIC-positive and SIC-negative groups on days 2, 4, and 7 ( P < .01, respectively), while significant differences were seen between JAAM-DIC-positive and JAAM-DIC-negative groups only on days 4 and 7 ( P < .05, .01, respectively). In summary, the SIC characteristics were similar to the JAAM-DIC group, and the classifications were comparable in terms of mortality prediction. The SIC scoring system is simple, easy to use, and adaptable to the new sepsis definitions and offers an important approach to evaluating patients in emergency and critical care settings.

Keywords: diagnostic criteria; disseminated intravascular coagulation; platelet count; prothrombin time; sepsis.

Figure 1.

Distribution and mortality of patients according to the SIC and JAAM-DIC diagnostic criteria. Each figure shows a comparison of the SIC and JAAM-DIC criteria. The numbers represent the number of cases in each category, and the numbers in parentheses are for nonsurvivors and the mortality rate. DIC indicates disseminated intravascular coagulation; JAAM, Japanese Association for Acute Medicine; SIC, sepsis-induced coagulopathy.

Figure 2.

Patient numbers and mortality rates according to the SIC and JAAM-DIC score classifications. The patient distributions (bars) and the mortality rates (lines) are plotted according to the SIC scores (above) and the JAAM-DIC scores (below). The x-axis represents the score. The mortality rate increased as the SIC score increased except for score 3 on day 1. For the JAAM-DIC criteria, the mortality rate was higher for score 4 than for scores 5 or 6 on day 1. DIC indicates disseminated intravascular coagulation; JAAM, Japanese Association for Acute Medicine; SIC, sepsis-induced coagulopathy.

Figure 3.

Patient numbers and mortality rates according to the SIC and JAAM-DIC score classifications. The patient distributions (bars) and the mortality rates (lines) are plotted according to the SIC scores (above) and the JAAM-DIC scores (below) on Day 4 and 7. The x-axis represents the score. For the JAAM-DIC criteria, the mortality did not increase linearly along with the increase of DIC score. SIC, sepsis-induced coagulopathy; JAAM, Japanese Association for Acute Medicine; DIC, disseminated intravascular coagulation.