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Prediction of survival in patients suspected of disseminated intravascular coagulation
Author(s) -
Hjorleifsson E.,
Sigurdsson M. I.,
Gudmundsdottir B. R.,
Sigurdsson G. H.,
Onundarson P. T.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12537
Subject(s) - medicine , disseminated intravascular coagulation , antithrombin , gastroenterology , surgery , heparin
Background Although antithrombin ( AT ), protein C ( PC ), and antiplasmin ( AP ) are consumed during disseminated intravascular coagulation ( DIC ), their association with mortality in patients initially suspected of acute DIC is unknown. We examined how these proteins associate with mortality in consecutive patients initially suspected of DIC , fulfilling or not fulfilling overt DIC criteria. Methods All consecutive patients clinically suspected of acute DIC during 5 years at a tertiary referral hospital were scored according to overt International Society of Thrombosis and Haemostasis ( ISTH ) DIC criteria. The influence of ISTH DIC score and measurements of AT , PC , and AP measured in all on mortality was assessed. Results During 1825 occurrences in 1814 patients, 91 fulfilled ISTH criteria for overt DIC (score ≥ 5). Both 28‐day and 1‐year mortality increased progressively as AT and in particular PC decreased. AT and PC correlated inversely with ISTH score ( AT : R 2 = 0.14, P < 0.001, PC : R 2 = 0.21, P < 0.001). AP decreased when ISTH score of > 3 was reached. The 28‐day mortality was 3%, 11%, 16%, 23%, 35%, and 52% and 1‐year mortality 5%, 18%, 24%, 36%, 54%, and 63%, respectively for patients with an ISTH score of 0, 1, 2, 3, 4, and ≥5 ( P < 0.001 for all). Conclusions Lowered AT and in particular PC activity was predictive of mortality risk upfront in critically ill patients suspected of acute DIC . Mortality in patients suspected of acute DIC increased progressively across the spectrum of the overt ISTH score and not only in those fulfilling overt DIC criteria.