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. 1999 Jan;229(1):121-7.
doi: 10.1097/00000658-199901000-00016.

Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma: application of clinical decision analysis

S Gando  1 , S Nanzaki, O Kemmotsu
Affiliations

Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma: application of clinical decision analysis

S Gando et al. Ann Surg. 1999 Jan.

Abstract

Objective: To determine the accuracy of disseminated intravascular coagulation (DIC) and sustained systemic inflammatory response syndrome (SIRS) in predicting posttrauma multiple organ dysfunction syndrome (MODS) and to find a simple laboratory test for detecting MODS.

Summary and background data: In trauma patients, the duration of SIRS is the main determinant for MODS and outcome.

Methods: One hundred thirty-six patients with trauma were classified into subgroups according to the duration of SIRS: patients without SIRS (n = 27), patients with SIRS for <2 days (n = 52), and patients with SIRS for > or =3 days (n = 57). Platelets and five coagulation and fibrinolytic laboratory tests for diagnosing DIC were measured on the day of admission and on days 1 through 4 after admission. Simultaneously, the DIC score was determined. The diagnostic accuracy of DIC and sustained SIRS for the prediction of MODS was determined using likelihood ratios. A receiver operating characteristic curve of platelet counts for predicting MODS was also constructed.

Results: Platelet counts showed significant differences among the three groups. The incidence of DIC, acute respiratory distress syndrome, and MODS was significantly higher in patients with SIRS for > or =3 days compared with those in the other groups, and they had a poor outcome. Likelihood ratios of DIC and SIRS for > or =3 days for predicting posttrauma MODS were 11.6 and 6.25, respectively. Platelet counts (80 x 10(9)/l) on day 1 had a sensitivity of 83.3% and a specificity of 100% for predicting MODS.

Conclusions: Disseminated intravascular coagulation and sustained SIRS are strong determinants for posttrauma MODS. This retrospective analysis supports the possibility that platelet counts can be used as a simple laboratory test for predicting MODS. This hypothesis requires proof using a prospective clinical survey.

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