OUTCOMES OF OVERT AND NON-OVERT DISSEMINATED INTRAVASCULAR COAGULATION USING THE ISTH DIC SCORING SYSTEM IN CHILDREN: A SINGLE-CENTER STUDY
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Keywords
children, DIC, infection, mortality
Abstract
Background: Several disseminated intravascular coagulation (DIC) scoring systems are used for prognosticating the clinical outcomes of patients with DIC. However, research on children is scarce. This study compared the clinical outcomes of overt and non-overt DIC using the International Society on Thrombosis and Hemostasis (ISTH) DIC scoring system.
Methods: This retrospective study reviewed data on children aged 1 month to 15 years diagnosed with DIC between 2003 and 2014.
Results: Of 244 patients, 179 (73.4%) had overt DIC, and 65 (26.6%) had non-overt DIC. The most common causes were infection (84.8%), tissue injury (7%), and malignancies (2.9%). The 28-day case fatality rate was significantly higher for overt than non-overt DIC (76% vs 15.6%; P < 0.001). DIC scores were significantly associated with mortality (R2 = 0.89). Each clinical parameter (platelet count, prothrombin time, and fibrin degradation products) was associated with mortality (P = 0.01). On multivariable analysis, the factors associated with death were platelet counts ≤ 50 000 cells/mm3 (OR, 2.42; 95% CI, 1.08–5.42; P = 0.031); overt DIC score (OR, 7.62; 95% CI, 2.94–19.75; P < 0.001); renal dysfunction (OR, 2.92; 95% CI, 1.34–6.37; P = 0.007); shock (OR, 39.62; 95% CI, 4.99–314.84; P = 0.001); and acute respiratory distress syndrome (OR, 25.90; 95% CI, 3.12–214.80; P = 0.003).
Conclusions: The 28-day case-fatality rate was significantly higher for patients with overt than non-overt DIC and concordant with ISTH scores. ISTH DIC scores can be used as a clinical predictor for DIC in children.
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References
2. Kongstad C, Mikkelsen TS, Hvas AM. Disseminated intravascular coagulation in children with cancer: A systematic review. Pediatr Hematol Oncol 2020; 37: 390-411.
3. Niederwanger C, Bachler M, Hell T, et al. Inflammatory and coagulatory parameters linked to survival in critically ill children with sepsis. Ann Intensive Care 2018; 8: 111. https://doi.org/10.1186/s13613-018-0457-8
4. Taylor FB, Jr., Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86: 1327-1330.
5. Helms J, Severac F, Merdji H, et al. Performances of disseminated intravascular coagulation scoring systems in septic shock patients. Ann Intensive Care 2020; 10: 92. https://doi.org/10.1186/s13613-020-00704-5
6. Grafeneder J, Krychtiuk KA, Buchtele N, et al. The ISTH DIC score predicts outcome in non-septic patients admitted to a cardiovascular intensive care unit. Eur J Intern Med 2020; 79: 37-42. https://www.sciencedirect.com/science/article/pii/S0953620520302557
7. Ören H, Cingöz I, Duman M, Yılmaz S, Irken G. DISSEMINATED INTRAVASCULAR COAGULATION IN PEDIATRIC PATIENTS: Clinical and Laboratory Features and Prognostic Factors Influencing the Survival. Pediatr Hematol Oncol 2005; 22: 679-688. https://doi.org/10.1080/08880010500278749
8. Okamoto K, Wada H, Hatada T, et al. Frequency and hemostatic abnormalities in pre-DIC patients. Thromb Res 2010; 126: 74-78. https://www.sciencedirect.com/science/article/pii/S0049384810002069
9. Wu Y, Luo L, Niu T, et al. Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: A multicenter prospective study. Sci Rep 2017; 7: 9057. https://doi.org/10.1038/s41598-017-09190-5
10. Nurnaningsih, Sunbanu SE, Rusmawatiningtyas D, Arguni E, Makrufardi F, Kumara IF. Disseminated intravascular coagulation initial score as a predictor of mortality in children with dengue shock syndrome: A retrospective cohort study. Ann Med Surg 2022; 79: 103890. https://www.sciencedirect.com/science/article/pii/S2049080122006501
11. Okajima K, Sakamoto Y, Uchiba M. Heterogeneity in the incidence and clinical manifestations of disseminated intravascular coagulation: a study of 204 cases. Am J Hematol 2000; 65: 215-222.
12. Ohbe H, Yamakawa K, Taniguchi K, et al. Underlying Disorders, Clinical Phenotypes, and Treatment Diversity among Patients with Disseminated Intravascular Coagulation. Jma J 2020; 3: 321-329.
13. Mahanupap P, Angchaisuksiri P, Rattanasiri S. Disseminated Intravascular Coagulation in Ramathibodi Hospital. J Hem Transfus Med 2010; 20: 27-38.
14. Khemani RG, Bart RD, Alonzo TA, Hatzakis G, Hallam D, Newth CJL. Disseminated intravascular coagulation score is associated with mortality for children with shock. Intensive Care Med 2009; 35: 327-333. https://doi.org/10.1007/s00134-008-1280-8
15. Kunwar S, Alam M, Ezekwueme F, et al. Diagnostic Scores and Treatment Options for Acute Disseminated Intravascular Coagulation in Children. Cureus 2021; 13: e17682.
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