• Yutaka Umemura, Kazuma Yamakawa, Mineji Hayakawa, Toshimitsu Hamasaki, Satoshi Fujimi, and Japan Septic Disseminated Intravascular Coagulation (J-Septic DIC) study group.
• Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
• Thromb. Res. 2018 Jan 1; 161: 60-66.

ObjectivesScreening of patients with sepsis for disseminated intravascular coagulation (DIC) has been recommended in several guidelines. However, DIC screening is still not widely accepted as an essential component of sepsis management, partly because of a lack of evidence that DIC screening has an effect on mortality. We investigated whether DIC screening was associated with a survival benefit in patients with sepsis.DesignPost hoc analysis of a nationwide multicenter retrospective cohort study.Setting42 intensive care units in Japan.Participants2663 adult patients diagnosed as having severe sepsis: 1893 (71.1%) patients were considered candidates for and 770 (28.9%) patients were not considered candidates for International Society of Thrombosis and Hemostasis (ISTH) overt DIC screening on ICU day 1.Main Outcome MeasuresThe primary outcome measure was all-cause in-hospital mortality. Patients were stratified according to whether DIC screening was performed at the time of ICU admission (day 1) to investigate the survival effect associated with DIC screening. We also evaluated survival benefit by classifying patients according to whether DIC screening was performed on day 1 and repeated on day 3. Effects of screening on mortality were assessed using Cox proportional hazards models adjusted by the inverse probability of treatment weighting (IPTW) method using propensity scoring.ResultsAfter adjustment for imbalances, ISTH overt DIC screening on day 1 was associated with significantly lower mortality (IPTW-adjusted HR: 0.836; 95% confidence interval [CI]: 0.711-0.984), and this association became even stronger when ISTH overt DIC screening was repeated on day 3 (IPTW-adjusted HR: 0.727; 95% CI: 0.597-0.884). Besides, we observed an almost comparable effect on mortality associated with DIC screening using the Japanese Association for Acute Medicine criteria.ConclusionDIC screening was associated with a reduction in mortality in patients with sepsis. This association could be even stronger by repeating DIC screening.Copyright © 2017 Elsevier Ltd. All rights reserved.

18 keywords...

hide…