Mortality, diagnosis, and etiology of disseminated intravascular coagulation-a systematic review and meta-analysis: communication from the ISTH SSC subcommittee on disseminated intravascular coagulation

Abstract

Background: Establishing global standards for diagnosis and treatment of disseminated intravascular coagulation (DIC) requires a comprehensive evaluation of its global epidemiology. However, obtaining epidemiologic evidence on DIC from a single cohort study is challenging.

Objectives: We aimed to evaluate global epidemiology and mortality of DIC by conducting a systematic literature review.

Methods: We conducted proportional meta-analyses of observational studies on DIC patients. We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials and selected studies reporting mortality of patients with DIC. The diseases underlying DIC included sepsis, trauma, solid cancer, hematologic neoplasia, burn, heat stroke, snakebite, and others. We measured all-cause mortality as the primary outcome.

Results: Among 119 studies, the most common diseases underlying DIC were sepsis in 52 studies and trauma in 31 studies. The International Society on Thrombosis and Haemostasis overt DIC and the Japanese Association for Acute Medicine DIC criteria were most frequently used to diagnose DIC. Pooled odds ratio (ie, increased risk) of mortality associated with development of DIC varied depending on the underlying disease: 3.15 in sepsis and 4.80 in trauma. Pooled raw mortality of DIC patients also varied widely by underlying disease: 42% in sepsis, 36% in trauma, 8% in snakebite, 28% in leukemia, and 32% in heat stroke. Pooled mortality and odds ratio for mortality also varied by the diagnostic criteria. We observed no clear yearly trend of improvement in mortality.

Conclusion: Mortality of DIC is very high but heterogeneous depending on underlying disease and diagnostic criteria, which should be taken into consideration in standardization of diagnosis and treatment of DIC.

Keywords: blood coagulation disorders; diagnosis; disseminated intravascular coagulation; epidemiology; meta-analysis.