TY - JOUR
T1 - A multicenter, prospective validation study of the Japanese association for acute medicine disseminated intravascular coagulation scoring system in patients with severe sepsis
AU - Gando, Satoshi
AU - Saitoh, Daizoh
AU - Ogura, Hiroshi
AU - Fujishima, Seitaro
AU - Mayumi, Toshihiko
AU - Araki, Tsunetoshi
AU - Ikeda, Hiroto
AU - Kotani, Joji
AU - Kushimoto, Shigeki
AU - Miki, Yasuo
AU - Shiraishi, Shin ichiro
AU - Suzuki, Koichiro
AU - Suzuki, Yasushi
AU - Takeyama, Naoshi
AU - Takuma, Kiyotsugu
AU - Tsuruta, Ryosuke
AU - Yamaguchi, Yoshihiro
AU - Yamashita, Norio
AU - Aikawa, Naoki
N1 - Funding Information:
This study was funded and supported by the JAAM. This study was approved by the JAAM and by the following institutional review boards or ethics committees of each hospital: Institutional Review Board of Hokkaido University Hospital for Clinical Research; Ethics Committee of Nagoya University of Graduate School of Medicine; Ethics Committee of Keio University School of Medicine; Fujita Health University ethical review board for epidemiological and clinical studies; Teikyo University Review Board; Ethics Committee of Nippon Medical School Hospital; Ethics Committee of Nippon Medical School Hospital; Center for Clinical Research, Yamaguchi University Hospital; The Ethics Review Board of Hyogo College of Medicine; Ethics Committee of Osaka University Hospital; Ethics Committee of Kyorin University; Ethics Committee of Tohoku University Hospital; Ethics Committee of Kawasaki Municipal Hospital; The Ethical Committee of Kurume University; and Research Ethics Committee of Kawasaki Medical School and Hospital.
PY - 2013/6/20
Y1 - 2013/6/20
N2 - Introduction: To validate the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) scoring system in patients with severe sepsis, we conducted a multicenter, prospective study at 15 critical care centers in tertiary care hospitals. Methods: This study included 624 severe sepsis patients. JAAM DIC was scored on the day of diagnosis of severe sepsis (day 1) and day 4. Scores for disease severity and organ dysfunction were also evaluated. Results: The prevalence of JAAM DIC was 46.8% (292/624), and 21% of the DIC patients were scored according to the reduction rate of platelets. The JAAM DIC patients were more seriously ill and exhibited more severe systemic inflammation, a higher prevalence of multiple organ dysfunction syndrome (MODS) and worse outcomes than the non-DIC patients. Disease severity, systemic inflammation, MODS and the mortality rate worsened in accordance with an increased JAAM DIC score on day 1. The Kaplan-Meier curves demonstrated lower 1-year survival in the JAAM DIC patients than in those without DIC (log-rank test P <0.001). The JAAM DIC score on day 1 (odds ratio = 1.282, P <0.001) and the Delta JAAM DIC score (odds ratio = 0.770, P <0.001) were independent predictors of 28-day death. Dynamic changes in the JAAM DIC score from days 1 to 4 also affected prognoses. The JAAM DIC scoring system included all patients who met the International Society on Thrombosis and Haemostasis overt DIC criteria on day 1. The International Society on Thrombosis and Haemostasis scoring system missed a large number of nonsurvivors recognized by the JAAM scoring system. Conclusions: The JAAM DIC scoring system exhibits good prognostic value in predicting MODS and poor prognosis in patients with severe sepsis and can detect more patients requiring treatment. Conducting repeated daily JAAM scoring increases the ability to predict the patient's prognosis.
AB - Introduction: To validate the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) scoring system in patients with severe sepsis, we conducted a multicenter, prospective study at 15 critical care centers in tertiary care hospitals. Methods: This study included 624 severe sepsis patients. JAAM DIC was scored on the day of diagnosis of severe sepsis (day 1) and day 4. Scores for disease severity and organ dysfunction were also evaluated. Results: The prevalence of JAAM DIC was 46.8% (292/624), and 21% of the DIC patients were scored according to the reduction rate of platelets. The JAAM DIC patients were more seriously ill and exhibited more severe systemic inflammation, a higher prevalence of multiple organ dysfunction syndrome (MODS) and worse outcomes than the non-DIC patients. Disease severity, systemic inflammation, MODS and the mortality rate worsened in accordance with an increased JAAM DIC score on day 1. The Kaplan-Meier curves demonstrated lower 1-year survival in the JAAM DIC patients than in those without DIC (log-rank test P <0.001). The JAAM DIC score on day 1 (odds ratio = 1.282, P <0.001) and the Delta JAAM DIC score (odds ratio = 0.770, P <0.001) were independent predictors of 28-day death. Dynamic changes in the JAAM DIC score from days 1 to 4 also affected prognoses. The JAAM DIC scoring system included all patients who met the International Society on Thrombosis and Haemostasis overt DIC criteria on day 1. The International Society on Thrombosis and Haemostasis scoring system missed a large number of nonsurvivors recognized by the JAAM scoring system. Conclusions: The JAAM DIC scoring system exhibits good prognostic value in predicting MODS and poor prognosis in patients with severe sepsis and can detect more patients requiring treatment. Conducting repeated daily JAAM scoring increases the ability to predict the patient's prognosis.
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U2 - 10.1186/cc12783
DO - 10.1186/cc12783
M3 - Article
C2 - 23787004
AN - SCOPUS:84879071665
SN - 1364-8535
VL - 17
JO - Critical Care
JF - Critical Care
IS - 3
M1 - R111
ER -