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Thromb Haemost
DOI: 10.1055/a-2530-7553
Coagulation and Fibrinolysis

Utility of Sepsis-induced Coagulopathy among Disseminated Intravascular Coagulation Diagnostic Criteria: A Multicenter Retrospective Validation Study

Satoshi Gando 
1   Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
2   Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
,
Takeshi Wada 
1   Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
,
Kazuma Yamakawa
3   Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
,
Toshikazu Abe
4   Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
5   Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
6   Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Japan
,
Seitaro Fujishima
7   Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
,
Shigeki Kushimoto
8   Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Toshihiko Mayumi
9   Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
,
Hiroshi Ogura
10   Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
,
Daizoh Saitoh
11   Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
,
Atsushi Shiraishi
12   Emergency and Trauma Center, Kameda Medical Center, Kamogawa, Japan
,
Yutaka Umemura
13   Devision of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
,
Yasuhiro Otomo
14   National Hospital Organization (NHO) Disaster Medical Center, Tokyo, Japan
,
on behalf of the Japanese Association for Acute Medicine (JAAM)› Author Affiliations
Funding This study was supported by JSPS KAKENHI Grant no. 23K08455 and a Japan Blood Products Organization 2024 scholarship.
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Abstract

Background

The criteria for diagnosing sepsis-induced coagulopathy (SIC) may overlap with those of Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC). This study determined if the diagnostic criteria of SIC overlap with JAAM DIC diagnostic criteria for identifying patients with DIC according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and whether the patients diagnosed with these criteria have the same prognosis.

Methods

This multicenter retrospective study included patients with sepsis diagnosed using the JAAM and ISTH DIC and SIC criteria on days 1 and 4. The established ISTH DIC criteria was the reference standard for primary outcome that compared the characteristics of SIC and JAAM DIC. Secondary outcomes were multiple organ dysfunction syndrome (MODS), ventilator-free and intensive care unit–free days, and in-hospital mortality.

Results

A total of 1,438 patients were included in this study. On day 1, the JAAM DIC and SIC criteria diagnosed almost all patients with ISTH DIC (98 and 94%, respectively), predicting ISTH DIC (area under the receiver operating curve [AUC]: 0.740 versus 0.752, p = 0.523) and MODS (AUC: 0.686 versus 0.697, p = 0.546) on day 4 and progressing to ISTH DIC in the same proportion (28.6 versus 30.1%, p = 0.622). There were no differences in survival probabilities (p = 0.196) or secondary outcomes between patients diagnosed using JAAM DIC and SIC criteria on day 1.

Conclusion

SIC and JAAM DIC diagnoses were equal among patients with sepsis, suggesting that SIC criteria add little to current DIC scoring systems.

Keywords

diagnosis - disseminated intravascular coagulation - prognosis - sepsis - sepsis-induced coagulopathy

Data Availability Statement

Datasets supporting the conclusions of this article will be provided upon reasonable request to the corresponding author.


Authors' Contribution

S.G., T.W., K.Y., T.A., S.F., S.K., T.M., H.O., D.S., A.S., Y.U., and Y.O. planned the study, determined the methods, developed a web-based registration system, and collected, analyzed, and interpreted the data. T.A., D.S., A.S., and Y.U. constructed the dataset and fixed it for analysis. S.G. and W.A. drafted the manuscript. Y.O. supervised all study processes and approved the study. All the authors discussed the results, critically revised the manuscript, edited the figures and tables, and approved the final version.


Supplementary Material



Publication History

Received: 16 October 2024

Accepted: 31 January 2025

Accepted Manuscript online:
03 February 2025

Article published online:
27 February 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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