Characteristics, treatments, and outcomes of severe sepsis of 3195 ICU-treated adult patients throughout Japan during 2011–2013

Hayakawa, Mineji; Saito, Shinjiro; Uchino, Shigehiko; Kudo, Daisuke; Iizuka, Yusuke; Sanui, Masamitsu; Takimoto, Kohei; Mayumi, Toshihiko; Azuhata, Takeo; Ito, Fumihito; Yoshihiro, Shodai; Hayakawa, Katsura; Nakashima, Tsuyoshi; Ogura, Takayuki; Noda, Eiichiro; Nakamura, Yoshihiko; Sekine, Ryosuke; Yoshikawa, Yoshiaki; Sekino, Motohiro; Ueno, Keiko; Yuko, Okuda; Watanabe, Masayuki; Tampo, Akihito; Saito, Nobuyuki; Kitai, Yuya; Takahashi, Hiroki; Kobayashi, Iwao; Kondo, Yutaka; Matsunaga, Wataru; Nachi, Sho; Miike, Toru; Takauji, Shuhei; Umakoshi, Kensuke; Todaka, Takafumi; Kodaira, Hiroshi; Andoh, Kohkichi; Kasai, Takehiko; Iwashita, Yoshiaki; Arai, Hiroyuki; Murata, Masato; Yamane, Masahiro; Shiga, Kazuhiro; Hori, Naoto

doi:10.1186/s40560-016-0169-9

Cited by 34 publications

(44 citation statements)

References 10 publications

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“…As tissue malcirculation is the essential factor in the progression to septic organ failure, DIC and shock are the two crucial complications that can affect patient outcome . A recent survey revealed that approximately one‐third of patients with sepsis who were treated in the intensive care unit (ICU) had shock as a complication, and more than half of them had DIC . The effectiveness of anticoagulant therapy for sepsis‐associated DIC has been intensively studied in Japan, and recent studies have repeatedly reported that anticoagulant therapy is only effective in patients with severe coagulopathy and DIC .…”

Section: Importance Of Diagnosing Dic In Sepsismentioning

confidence: 99%

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

Iba

Umemura

Watanabe

et al. 2019

Acute Medicine & Surgery

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Disseminated intravascular coagulation (DIC) is a frequent complication in sepsis. Once patients develop DIC, the mortality rate increases significantly. Moreover, recent studies have suggested that coagulation disorder plays a significant role in the development of organ dysfunction in sepsis. Thus, the early detection of DIC is vital in sepsis care, and the Japanese Association for Acute Medicine established a set of original diagnostic criteria in 2006 (JAAM DIC). Since then, the usefulness of the JAAM DIC has been repeatedly reported, and these criteria have been widely adopted in emergency and critical care settings in Japan. Different criteria have also been released by the International Society on Thrombosis and Haemostasis (ISTH overt‐DIC), and the latter criteria are presently considered to be the international standard. Compared with the JAAM DIC, the ISTH overt‐DIC criteria are stricter and the timing of diagnosis is later. This discrepancy is because of conceptual differences. As many physicians think sepsis‐associated DIC is the target of anticoagulant therapies in Japan, the JAAM DIC criteria were designed to allow the early initiation of treatment. As other countries do not provide DIC‐specific treatments, early diagnosis is not necessary, and this situation has led to a significant gap. However, as overt‐DIC is a late‐phase coagulation disorder, a need for early detection has been advocated, and members of the ISTH have recently proposed the category of sepsis‐induced coagulopathy. In this review, we introduce the strengths and weaknesses of the major criteria including JAAM‐DIC, ISTH overt‐DIC, sepsis‐induced coagulopathy, and Japanese Society on Thrombosis and Haemostasis‐DIC.

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Section: Importance Of Diagnosing Dic In Sepsismentioning

confidence: 99%

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

Iba

Umemura

Watanabe

et al. 2019

Acute Medicine & Surgery

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“…Recombinant human soluble thrombomodulin (rhTM), like AT, is frequently used as an anticoagulant for treating DIC 18, 23. Thrombomodulin is a receptor of thrombin and protein C on the endothelial cell surface and plays an important role in the regulation of coagulation and the innate immune system 24.…”

Section: Recombinant Human Soluble Thrombomodulinmentioning

confidence: 99%

“…Therefore, we undertook a nationwide multicenter retrospective observational study, named the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study, which reported the effects of anticoagulant therapy on sepsis in real world clinical settings 18, 19, 20, 21. Herein, we present a summary of the JSEPTIC DIC study.…”

Section: Introductionmentioning

confidence: 99%

A summary of the Japan septic disseminated intravascular coagulation study

Hayakawa

Ono

2018

Acute Medicine & Surgery

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Over the past few decades, the large, international, randomized controlled trials of anticoagulant therapies for patients with sepsis have not yielded any improvement in mortality rates. However, in Japan, anticoagulant therapies are administered for sepsis patients with disseminated intravascular coagulation (DIC), but not for sepsis patients without DIC. Furthermore, epidemiological data regarding sepsis in Japan are scarce. Therefore, a nationwide multicenter retrospective observational study, the Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study, was undertaken. The JSEPTIC DIC study enrolled 42 intensive care units and included 3,195 patients with sepsis. The results of the JSEPTIC DIC study indicated the following: (i) anticoagulant therapy may be effective in sepsis‐induced DIC patients at high risk for death, (ii) recombinant human soluble thrombomodulin administration and antithrombin supplementation are associated with survival benefits in patients with sepsis‐induced DIC.

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“…JAAM DIC criteria demonstrate high sensitivity and specificity for the diagnosis of DIC(52), and all patients diagnosed with the JAAM criteria were further examined by the criteria of the International Society of Hemostasis and Thrombosis (ISTH) as overt DICs(53). The registry of the JSEPTIC DIC(54) study enrolled 3195 cases with severe sepsis/septic shock over a two-year interval between 2011-2013, with a critically ill population as demonstrated by high mean APACHE II scores (23.1 ± 8.7) and an overall in-hospital mortality rate of 34%. Patients identified as having DIC who were administered anti-coagulation therapy received anti-thrombin first as standard of care, and rh-TM was added if AT was deemed to be ineffective in treating DIC.…”

Section: Pro: Coagulopathy Should Be a Therapeutic Target In Criticalmentioning

confidence: 99%

Is Coagulopathy an Appropriate Therapeutic Target During Critical Illness Such as Trauma or Sepsis?

Moore

Winfield

Aibiki

et al. 2017

Shock

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Coagulopathy is a common and vexing clinical problem in critically ill patients. Recently, major advances focused on the treatment of coagulopathy in trauma and sepsis have emerged. However, the targeting of coagulopathy with blood product transfusion and drugs directed at attenuating the physiologic response to these conditions have major potential risk to the patient. Therefore, the identification of coagulopathy as a clinical target is an area of uncertainty and controversy. In order to analyze the state of the science regarding coagulopathy in critical illness, a symposium addressing the problem was organized at the 39th annual meeting of the Shock Society in the summer of 2016. This manuscript synthesizes the viewpoints of the four expert panelists at the debate and presents an overview of the potential positive and negative consequences of targeting coagulopathy in trauma and sepsis.

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Characteristics, treatments, and outcomes of severe sepsis of 3195 ICU-treated adult patients throughout Japan during 2011–2013

Cited by 34 publications

References 10 publications

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

A summary of the Japan septic disseminated intravascular coagulation study

Is Coagulopathy an Appropriate Therapeutic Target During Critical Illness Such as Trauma or Sepsis?

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