Biomarkers of disseminated intravascular coagulation in pediatric intensive care unit in Thailand

Disseminated intravascular coagulation ( DIC ) is a systemic activation of hemostatic system caused by several causes. Biomarkers including antithrombin ( AT ), protein C ( PC ), and thrombomodulin ( TM ) were reported as the additional markers for DIC in adults. This study aimed to determine the association between biomarkers among patients with overt DIC ( ODIC ) and nonovert DIC ( NDIC ) in children in PICU . Methods We enrolled 103 subjects, aged 1 month‐18 years, who were admitted to PICU at Chiang Mai University ( CMU ) Hospital >24 hours with underlying conditions predisposing to DIC were enrolled. Biomarkers were tested after 24 hours of admission. Subject who had NDIC on the 1 st investigations would have other tests on days 3‐5 of admission. Results The incidence of ODIC by the International Society on Thrombosis and Hemostasis ( ISTH ) DIC score was found 24%. The bleeding, thrombosis, and death were significantly higher in ODIC group ( P  <   0.05). Mean levels of AT and PC in ODIC group were significantly different from NDIC one (66.9% vs 79.9%, P <  0.001 and 46.1% vs 59.2%, P  =   0.004, respectively) while mean level of TM was not different between two groups. Adding AT to DIC score was better than the original score for predict mortality [area under curve ( AUC ) = 0.662 vs AUC  = 0.65] and bleeding ( AUC  = 0.751 vs AUC  = 0.732). Conclusions ODIC is prevalent among critically ill children. Adverse outcomes were more commonly found in children with ODIC . AT and PC levels after 24 hours of PICU admission seem to be the useful biomarkers for ODIC in PICU .