Sepsis-Induced Coagulopathy and Japanese Association for Acute Medicine DIC in Coagulopathic Patients with Decreased Antithrombin and Treated by Antithrombin

Abstract

Disseminated intravascular coagulation (DIC) in patients with sepsis represents a critical condition. Thus, a simple and rapid diagnosis is required. The purpose of this study was to compare the performances of a recently developed Sepsis-Induced Coagulopathy (SIC) with the Japanese Association for Acute Medicine (JAAM) DIC. Four hundred nine patients with sepsis having coagulopathy and antithrombin activity of less than 70% and treated with antithrombin were retrospectively analyzed, and the SIC and JAAM-DIC criteria on days 1 (before treatment), 2, 4, and 7 were compared. The prevalence of JAAM-DIC on day 1 was significantly higher than that of SIC (91.4% vs 81.8%, P = .003), but there were no differences on days 2, 4, and 7. The mortality rates in the SIC and JAAM-DIC groups were both 23.3%. The specificity to 28-day mortality on day 1 was higher in the SIC group (15.8% vs 9.2%, P = .013). There were no differences in sensitivity on days 1, 2, 4, and 7. Mortality was significantly different between SIC-positive and SIC-negative groups on days 2, 4, and 7 ( P < .01, respectively), while significant differences were seen between JAAM-DIC-positive and JAAM-DIC-negative groups only on days 4 and 7 ( P < .05, .01, respectively). In summary, the SIC characteristics were similar to the JAAM-DIC group, and the classifications were comparable in terms of mortality prediction. The SIC scoring system is simple, easy to use, and adaptable to the new sepsis definitions and offers an important approach to evaluating patients in emergency and critical care settings.

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

“…A comparison of the SIC and JAAM DIC criteria was also carried out, and the prevalence of patients with SIC was comparable to that of patients with JAAM DIC. The SIC criteria also showed similar performance for predicting the 28‐day mortality as the JAAM DIC criteria . Thus, the SIC criteria were suggested to identify a category similar to that identified by the JAAM DIC criteria.…”

Diagnosis and management of sepsis‐induced coagulopathy and disseminated intravascular coagulation

“…It was found that almost all patients with overt DIC also met criteria for SIC, and that SIC preceded overt DIC in every case. In another study, SIC criteria appeared to identify a patient group similar to that identified using JAAM DIC criteria . The result was interesting because in SIC criteria, FDP/D‐dimer adopted by JAAM DIC criteria was eliminated and SIRS score was replaced with SOFA score.…”

“…The usefulness of the SIC score has been validated . The ISTH DIC SSC members compared SIC and ISTH overt DIC scoring systems in sepsis patients with coagulopathy .…”

“…The usefulness of the SIC score has been validated. [25][26][27][28] The ISTH DIC SSC members compared SIC and ISTH overt DIC scoring systems in sepsis patients with coagulopathy. 25 It was found that almost all patients with overt DIC also met criteria for SIC, and that SIC preceded overt DIC in every case.…”

“…In another study, SIC criteria appeared to identify a patient group similar to that identified using JAAM DIC criteria. 26 The result was interesting because in SIC criteria, FDP/D-dimer adopted by JAAM DIC criteria was eliminated and SIRS score was replaced with SOFA score. Another validation study 27 reported the usefulness of the SIC criteria based on a Japanese cohort of septic patients.…”