Applications of the international scoring system for Disseminated Intravascular Coagulopathy (DIC) and its interaction with Sequential Organ Failure Assessment Score (SOFA) in prediction of prognosis and final outcome in ICU

Abstract

IntroductionDisseminated Intravascular Coagulopathy (DIC) is a consumptive syndrome that is characterized by simultaneous widespread microvascular thrombosis and profuse bleeding from various sites. It is described as the combination of thrombocytopenia, decreased coagulation factors V and X causing prolonged prothrombin time, together with decreased fibrinogen and increased D-dimer levels. Objectives(1) To investigate the relation between DIC and increased mortality, (2) to explain the impact of the changes that occur in ISTH score for DIC in critically ill patients, (3) to determine the prognostic role of interacting DIC and SOFA scores in critically ill patients and their predictive capability when combined together than either score alone. DesignA prospective, comparative, cohort, non-controlled, single center study from July 2011 to January 2012. SettingIntensive care unit at Critical Care Department in Kasr-Alainy Hospital of Cairo University. PatientsFifty critically ill patients with APACHE II score ⩾25, not including those with disseminated malignancies, chronic liver failure, renal failure or chronic haematological disorders. MeasurementsFor all included patients with APACHE II score ⩾25 on admission, DIC and SOFA scores were calculated at baseline (on admission) and subsequently thereafter every 48h until ICU discharge or death or up to a total of 28days. Clinical outcome (duration of stay in the ICU, need for mechanical ventilation, need for inotropic/vasopressor support, need for haemodialysis, and final outcome of survival/mortality rates) were recorded. ResultsThrough follow up of DIC score trend in both groups (survivors and non-survivors); increasing value was associated with poor prognosis (96.8% of non-survivors had DIC score value on admission lower than that before death), while decreasing or constant value was associated with better prognosis (94.4% of non-survivors had DIC score value on admission higher than or equal to that before discharge). There was a significant correlation between combined DIC and SOFA scores together with mortality and final outcome in ICU (P value was 0.002 at day 4 and 0.012 on discharge or at death). ConclusionA significant correlation exists between SOFA and DIC scores together in critically ill patients with APACHE II score ⩾25 as regards MODS and mortality. The combination of DIC and SOFA scores highly improves the prognostic performance of either score alone. It's recommended to combine these scores together for better mortality prediction.