Epidemiology of disseminated intravascular coagulation in sepsis and validation of scoring systems

Purpose: We investigated the epidemiology and outcome of disseminated intravascular coagulation (DIC) in patients with sepsis. Materials and methods: We analyzed data from a multicenter observational study (Japan Septic Disseminated Intravascular Coagulation [JSEPTIC-DIC] study) conducted in 42 intensive care units in Japan. DIC scores were calculated using two scoring systems: the International Society on Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria. We compared demographics and clinical characteristics of patients with and without DIC, and performed multivariable logistic regression analyses to assess the association of diagnosis and scores for DIC with in-hospital mortality. Results: Of 1895 eligible patients, 1162 (61%) and 554 patients (29%) were diagnosed as having DIC by the JAAM and ISTH criteria, respectively. Patients with DIC had higher in-hospital mortality compared with those without DIC (33% vs. 20% in JAAM and 38% vs. 24% in ISTH). However, in multivariable analysis, the JAAM score (odds ratio 1.026, 95% confidence interval 0.958–1.097; p = 0.465) and the ISTH score (odds ratio 1.049, 95% confidence interval 0.969–1.135; p = 0.238) did not have an independent association with in-hospital mortality. Conclusions: Patients with sepsis and DIC have high mortality. However, the DIC are not independently associated with in-hospital mortality.