Risk factors of disseminated intravascular coagulation in septic systemic inflammatory response syndrome in nursing home residents

Abstract

Aims: Disseminated intravascular coagulation syndrome (DIC) is a serious complication in elderly patients with systemic inflammatory response syndrome (SIRS). We investigated whether the clinically relevant parameters of atherosclerosis, nutrition and cellular immunity are determining factors for DIC in septic SIRS patients or not. Patients and methods: Forty-four subjects aged 65 years or over were enrolled, all of whom had bacterial sepsis and a high concentration of C-reactive protein (≥ 15.0 mg/dL). Subjects were given gabexate mesilate (GM) following diagnosis of DIC. They were divided into the following groups: N-DIC, subjects with SIRS but not DIC (n = 22); DIC-A, subjects with SIRS and DIC who survived through treatment with GM (n = 6); and DIC-D, subjects who had SIRS and DIC and died despite treatment with GM (n = 16). Results: Subjects with a low hemoglobin or serum albumin concentration, and atrial fibrillation at admission had a significantly high incidence of DIC, which was not high in subjects with myocardial ischemia, past history of overt cerebral infarctions or periventricular lucency. There was no difference in hemoglobin concentration between DIC-A and DIC-D. Differences in increases in CD11b- and CD14-positive mononuclear cells between DIC and N-DIC subjects were not significant. Post-mortem examinations showed that the ratio of the width of the thoracic aorta to that of the abdominal aorta was significantly higher for DIC-D than DIC-A. Conclusion: Nutritional disorders and irregularity in aortic blood flow are significant risks of DIC. Treatment with GM alone is not sufficient to achieve survival in patients with DIC and SIRS.