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Disseminated intravascular coagulation immediately after trauma predicts a poor prognosis in severely injured patients. 2021
Takeshi Wada, and
Atsushi Shiraishi, and
Satoshi Gando, and
Kazuma Yamakawa, and
Seitaro Fujishima, and
Daizoh Saitoh, and
Shigeki Kushimoto, and
Hiroshi Ogura, and
Toshikazu Abe, and
Toshihiko Mayumi, and
Junichi Sasaki, and
Joji Kotani, and
Naoshi Takeyama, and
Ryosuke Tsuruta, and
Kiyotsugu Takuma, and
Norio Yamashita, and
Shin-Ichiro Shiraishi, and
Hiroto Ikeda, and
Yasukazu Shiino, and
Takehiko Tarui, and
Taka-Aki Nakada, and
Toru Hifumi, and
Kohji Okamoto, and
Yuichiro Sakamoto, and
Akiyoshi Hagiwara, and
Tomohiko Masuno, and
Masashi Ueyama, and
Satoshi Fujimi, and
Yutaka Umemura, and
Yasuhiro Otomo
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan. twada1@med.hokudai.ac.jp.
Trauma patients die from massive bleeding due to disseminated intravascular coagulation (DIC) with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of multiple organ dysfunction syndrome (MODS) and a consequently poor outcome. This is a sub-analysis of a multicenter prospective descriptive cross-sectional study on DIC to evaluate the effect of a DIC diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, MODS, and hospital death in severely injured trauma patients. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank P < 0.001), higher frequency of massive transfusion and MODS and a higher mortality rate than no such diagnosis. The DIC scores at 0 and 3 h significantly predicted massive transfusion, MODS, and hospital death. Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items. In conclusion, a DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.
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