Utility of sepsis-induced coagulopathy among disseminated intravascular coagulation diagnostic criteria: A multicenter retrospective validation study.

Abstract

Background: The criteria for diagnosing sepsis-induced coagulopathy (SIC) may overlap with those of Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC). We aimed to determine if the diagnostic criteria for SIC overlap with those for the JAAM DIC diagnosis of International Society on Thrombosis and Haemostasis (ISTH) DIC and whether patients have the same prognosis when diagnosed using these criteria.

Methods: This multicenter retrospective study included patients with sepsis diagnosed using the JAAM and ISTH DIC and SIC criteria on days 1 and 4. The established ISTH DIC criteria was reference standard for primary outcome that compared the characteristics of SIC and JAAM DIC. Secondary outcomes were multiple organ dysfunction syndrome (MODS), ventilator- and intensive care unit-free days, and in-hospital mortality.

Results: A total of 1,438 patients were included in this study. On day 1, the JAAM DIC and SIC criteria diagnosed almost all patients with ISTH DIC (98% and 94%, respectively), predicting ISTH DIC (area under the receiver operating curve [AUC]: 0.740 vs. 0.752, P = 0.523) and MODS (AUC: 0.686 vs. 0.697, P = 0.546) on day 4 and progressing to ISTH DIC in the same proportion (28.6 vs. 30.1%, P = 0.622). There were no differences in survival probabilities (P = 0.196) or secondary outcomes between patients diagnosed using JAAM DIC and SIC criteria on day 1.

Conclusion: SIC and JAAM DIC diagnoses were equal among patients with sepsis, suggesting that SIC criteria add little to current DIC scoring systems.