Acute and Critical Care

Original Article

Infection/Hematology
The Prevalence and Significance of Overt Disseminated Intravascular Coagulation in Patients with Septic Shock in the Emergency Department According to the Third International Consensus Definition: Byuk Sung Ko, Hyun Young Cho, Seung Mok Ryoo, Myung Chun Kim, Woong Jung, Sung Hyuk Park, Chang Min Lee, Won Young Kim; Korean J Crit Care Med. 2016;31(4):334-341. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00339

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Background
The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock.
Methods
We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality.
Results
Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]).
Conclusions
Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.

Citations

Citations to this article as recorded by

Which Septic Shock Patients With Non-Overt DIC Progress to DIC After Admission? Point-of-Care Thromboelastography Testing
Sang-Min Kim, Sang-Il Kim, Gina Yu, Youn-Jung Kim, Won Young Kim
Shock.2022; 57(2): 168. CrossRef
Dysregulated haemostasis in thrombo-inflammatory disease
Paula A. Klavina, Gemma Leon, Annie M. Curtis, Roger J.S. Preston
Clinical Science.2022; 136(24): 1809. CrossRef
Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan
Eman Mahmoud Qasim Emleek, Amani Anwar Khalil
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Features of Development and Course of Disseminated Intravascular Coagulation Syndrome During Surgical Interventions in Children with Oncological Diseases
N. P. Leonov, V. V. Schukin, G. A. Novichkova, M. A. Maschan, F. I. Ataullakhanov, S. S. Yashin, A. M. Zeynalov, Е. A. Spiridonova
General Reanimatology.2020; 16(3): 54. CrossRef
Relationship between low hemoglobin levels and mortality in patients with septic shock
Sung Min Jung, Youn-Jung Kim, Seung Mok Ryoo, Won Young Kim
Acute and Critical Care.2019; 34(2): 141. CrossRef

Case Reports

Neurosurgery/Hematology
Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis: Hyun Jin Baek, Doo Hyuk Lee, Kyu Hyung Han, Young Min Kim, Hyunbeom Kim, Byeongwook Cho, Inkuk Lee, Kanghyun Choi, Hojin Yong, Goohyeon Hong; Korean J Crit Care Med. 2016;31(2):134-139. Published online May 31, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.2.134

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226 Download
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Abstract PDF

In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.

Citations

Citations to this article as recorded by

Abdominal mass in a septic infant: Case of a fatal intraluminal intestinal hematoma
Mana Taweevisit, Paul Scott Thorner
Pediatric Hematology Oncology Journal.2021; 6(3): 139. CrossRef
Perforated Mesenteric Cyst with Sepsis and Neurological Complication in a 9 Month Old Child
Mandal KC, Saha D, Halder P, Chakraborty P, Debnath B, Mukhopadhyay B
Asploro Journal of Pediatrics and Child Health.2020; 2(1): 30. CrossRef

Neurosurgery
Delayed Traumatic Subarachnoid Hemorrhage in a Polytraumatized Patient with Disseminated Intravascular Coagulation: Jiwoong Oh, Wonyeon Lee, Ji Young Jang, Pilyoung Jung, Sohyun Kim, Jongyeon Kim, Jinsu Pyen, Kum Whang, Sungmin Cho; Korean J Crit Care Med. 2015;30(4):336-342. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.336

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137 Download
1 Crossref

Abstract PDF

The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multipletrauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and antithrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.

Citations

Citations to this article as recorded by

Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments?
Bedriye Müge Sönmez, Emirhan Temel, Murat Doğan İşcanlı, Fevzi Yılmaz, Uğur Gülöksüz, Selçuk Parlak, Özhan Merzuk Uçkun
Journal of the National Medical Association.2019; 111(2): 210. CrossRef

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