Disseminated Intravascular Coagulopathy Is Associated with the Outcome of Persistent Inflammation, Immunosuppression and Catabolism Syndrome

Kensuke Nakamura; Kentaro Ogura; Hidehiko Nakano; Hiromu Naraba; Yuji Takahashi; Tomohiro Sonoo; Hideki Hashimoto; Tadahiro Goto

doi:10.3390/jcm9082662

Disseminated Intravascular Coagulopathy Is Associated with the Outcome of Persistent Inflammation, Immunosuppression and Catabolism Syndrome

J Clin Med. 2020 Aug 17;9(8):2662. doi: 10.3390/jcm9082662.

Authors

Kensuke Nakamura¹, Kentaro Ogura^{2

3}, Hidehiko Nakano¹, Hiromu Naraba^{1

3}, Yuji Takahashi¹, Tomohiro Sonoo^{1

3}, Hideki Hashimoto¹, Tadahiro Goto^{3

4}

Affiliations

¹ Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan.
² Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo 113-0033, Japan.
³ TXP Medical Co. Ltd. 3-13 Nihonbashiyokoyamacho, Chuo-ku, Tokyo 103-0003, Japan.
⁴ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo 113-0033, Japan.

Abstract

Persistent inflammation, immunosuppression and catabolism syndrome (PIICS) often occur after critical care. Disseminated intravascular coagulation (DIC) is expected to be associated independently with PIICS development. We retrospectively analyzed 5397 patients admitted to the Hitachi General Hospital emergency and critical care center during four years. We classified PIICS as C-reactive protein > 3.0 mg/dL or albumin < 3.0 g/dL or lymphocyte count < 800/μL on day 14. Prolonged hospital stay (>14 days) without PIICS and early recovery (discharged alive within 14 days) were assigned as non-PIICS. Early death (death within 14 days) was identified. We analyzed the association between the International Society on Thrombosis and Haemostasis overt DIC and PIICS outcomes. Results revealed 488 PIICS, 416 early death and 4493 non-PIICS cases. Analyses showed DIC as associated significantly with mortality, the Barthel index at discharge and PIICS development. Multivariate regression analysis and a generalized structural equation model identified DIC on admission as an independent risk factor for PIICS in surviving patients.

Keywords: CRP; DIC; PICS; PIICS; coagulopathy; sepsis.