Time Trends of the Outcomes and Treatment Options for Disseminated Intravascular Coagulation: A Nationwide Observational Study in Japan

Abstract

Introduction: Existing evidence on the mortality time trends of patients with disseminated intravascular coagulation (DIC) is limited, and whether the mortality trend or quality of care of DIC patients has improved remains unknown. This study aimed to investigate the temporal trend in mortality, patient outcomes, and treatment preferences of several anticoagulants in Japan.

Methods: This retrospective observational study used the Japanese Diagnosis Procedure Combination inpatient database, which contains data from more than 1200 acute-care hospitals in Japan. We identified all adult patients that were diagnosed with DIC from July 2010 to March 2018 and sorted them into one of five predefined underlying conditions: sepsis, solid cancer, leukemia, trauma, or obstetric. The data collected as general outcomes were the 28-day mortality and major bleeding events. We also evaluated anticoagulant use for DIC treatment.

Results: A total of 325,327 DIC patients were included in this study. Regarding the baseline characteristics, an increase in median age, worsened comorbid conditions, and higher illness severity were observed over time. The underlying conditions for DIC were largely unchanged. Over the study period, the 28-day mortality for overall DIC patients decreased from 41.8% (95% CI 41.2%-42.3%) to 36.1% (95% CI 35.6%-36.6%), which is a 14% decrease over the 8-year period (P _trend < 0.001). The downward trend in mortality was more evident in patients with sepsis and leukemia (15% and 14% decreases, respectively), whereas no clinically meaningful change in mortality occurred in trauma and obstetrics patients. Over time, major bleeding events modestly increased, and the length of hospital stay decreased. The temporal trend in the treatment preferences of anticoagulants for DIC patients clearly changed over time.

Conclusions: The overall 28-day mortality for DIC patients clearly decreased from 2010 to 2017. The downward trend in mortality might have resulted from the advances made in the fundamental treatment of underlying diseases and from the changes in anti-DIC strategies.

Keywords: Anticoagulants; Cancer; DIC; Descriptive studies; Leukemia; Mortality trends; Sepsis.

Figure 1.

Patient flow diagram. DIC, disseminated intravascular coagulation; ICD, International Classification of Diseases.

Figure 2.

Twenty-eight day mortality for patients with disseminated intravascular coagulation (DIC), 2010-2017. (A) Overall DIC population, and (B) 28-day mortality according to different baseline diseases. Overall mortality in the DIC proportion increased from 2000 to 2017 (14% decrease; P_trend < 0.001). Similarly, there was a significant decrease in mortality across all different baseline diseases, except for obstetric patients with DIC.

Figure 3.

Time trends of anticoagulant uses for patients with disseminated intravascular coagulation, 2011-2017. (A) Overall, (B) sepsis, (C) solid cancer, (D) leukemia, (E) trauma, and (F) obstetric patients.