Abstract
BackgroundWe tested the hypothesis that disseminated intravascular coagulation (DIC) during the early phase of post-cardiopulmonary resuscitation (CPR) is associated with systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS) and affects the outcome of out-of-hospital cardiac arrest (OHCA) patients.MethodsA review of the computer-based medical records of OHCA patients was retrospectively conducted and included 388 patients who were divided into DIC and non-DIC patients based on the Japanese Association for Acute Medicine DIC diagnostic criteria. DIC patients were subdivided into two groups: those with and without hyperfibrinolysis. Pre-hospital factors, platelet count, coagulation and fibrinolysis markers and lactate levels within 24 h after resuscitation were evaluated. The outcome measure was all-cause hospital mortality.ResultsDIC patients exhibited lower platelet counts, prolonged prothrombin time, decreased levels of fibrinogen and antithrombin associated with increased fibrinolysis than those without DIC. DIC patients more frequently developed SIRS and MODS, followed by worse outcomes than non-DIC patients. The same changes were observed in DIC patients with hyperfibrinolysis who showed a higher prevalence of MODS, leading to worse outcome than those without hyperfibrinolysis. Logistic regression analyses showed that lactate levels predicted hyperfibrinolysis and DIC is an independent predictor of patient death. Survival probabilities of DIC patients during hospital stay were significantly lower than non-DIC patients. The area under the receiver operating characteristic curve of DIC for the prediction of death was 0.704.ConclusionsThe fibrinolytic phenotype of DIC during the early phase of post-CPR more frequently results in SIRS and MODS, especially in patients with hyperfibrinolysis, and affects the outcome of OHCA patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s12959-016-0116-y) contains supplementary material, which is available to authorized users.
Highlights
We tested the hypothesis that disseminated intravascular coagulation (DIC) during the early phase of post-cardiopulmonary resuscitation (CPR) is associated with systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS) and affects the outcome of out-of-hospital cardiac arrest (OHCA) patients
The lactate levels were significantly higher in those with hyperfibrinolysis than in those without fibrinolysis. These results suggest that DIC with hyperfibrinolysis is considered to be more severe DIC associated with extreme fibrin olysis and tissue hypoperfusion, which results in worse outcome
The results of the present study demonstrate that OHCA patients with DIC during the early phase of post CPR are at risk of SIRS and MODS and that their condition is associated with a poor prognosis
Summary
We tested the hypothesis that disseminated intravascular coagulation (DIC) during the early phase of post-cardiopulmonary resuscitation (CPR) is associated with systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS) and affects the outcome of out-of-hospital cardiac arrest (OHCA) patients. Post-resuscitation syndrome is referred to as postcardiac arrest syndrome consisting of four syndromes including systemic ischemia reperfusion responses and post-cardiac arrest brain injury [3]. Main pathophysiologies of the former responses are systemic inflammatory response syndrome (SIRS) and increased coagulation, which clinically manifest as tissue hypoxia/ischemia and multiple organ dysfunctions [3]. Recent studies have indicated that disseminated intravascular coagulation (DIC) leads to organ dysfunction and affects the prognosis of out-of-hospital cardiac arrest (OHCA) patients [5, 6]
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