Disseminated Intravascular Coagulation Immediately after Trauma Predicts a Poor Prognosis in Severely Injured Patients: A Sub-analysis of a Multicenter Prospective Study on Disseminated Intravascular Coagulation in Trauma

Abstract

Background: Trauma patients die from massive bleeding due to DIC with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of MODS and a consequent poor outcome. The aim of this study is to evaluate the effect of a disseminated intravascular coagulation (DIC) diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, multiple organ dysfunction syndrome (MODS), and hospital death in severely injured trauma patients.Methods: Severely injured adult patients (Injury Severity Score >16) were prospectively evaluated for their DIC scores and molecular markers of coagulation and fibrinolysis immediately after emergency department presentation (0 h) and 3 h after admission. Organ dysfunction was assessed by the sequential organ failure assessment (SOFA) score at 24 h after admission. The performance of DIC scores in predicting massive transfusion, MODS, and hospital death, and the effect of a DIC diagnosis on the survival probability were investigated.Results: The 276 enrolled patients included 121 DIC and 155 non-DIC patients. DIC patients showed larger transfusion volume and higher SOFA scores than non-DIC patients at 24 h after admission. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank p<0.001), higher frequency of massive transfusion and MODS, and higher mortality rate than no such diagnosis. DIC scores at 0 h and 3 h predicted massive transfusion, MODS, and hospital death with significance (all areas under the receiver operating characteristic curves, p<0.001). Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items.Conclusions: A DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.Trial registration: UMIN-CTR, UMIN000019588. Registered on 16 November 2015.