Abstract
Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, P<0.001). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC (P<0.001). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC (P<0.001). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay.
Highlights
Sepsis is the leading cause of mortality in noncardiac ICU admissions [1]
Those who developed Disseminated intravascular coagulation (DIC) were slightly younger in age, more likely to have positive blood cultures, and less likely to be on aspirin, but not clopidogrel
To the best of our knowledge, our study is among the first to evaluate clinical predictors for the development of overt DIC in septic shock patients treated with early goal-directed therapy (EGDT)
Summary
Sepsis is the leading cause of mortality in noncardiac ICU admissions [1]. The reported incidence of septic shock ranges from 6.3% to 14.7% [2]. Disseminated intravascular coagulation (DIC) is commonly seen in septic patients and is associated with an increased rate of morbidity and mortality [4]. DIC is defined by the International Society of Thrombosis and Hemostasis (ISTH) as “an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes. It can originate from and cause damage to the microvasculature. The diagnosis of overt DIC based on an ISTH DIC score ≥5 was found to be associated with high severity of disease and a fivefold increased risk of death [1], [6]
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