scholarly journals Disseminated intravascular coagulation immediately after trauma predicts a poor prognosis in severely injured patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takeshi Wada ◽  
Atsushi Shiraishi ◽  
Satoshi Gando ◽  
Kazuma Yamakawa ◽  
Seitaro Fujishima ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Survival Probability ◽  
Poor Prognosis ◽  
Massive Transfusion ◽  
Late Phase ◽  
Hospital Death ◽  
Trauma Patients ◽  
Severely Injured ◽  
Cross Sectional ◽  
Intravascular Coagulation

AbstractTrauma 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.

scholarly journals Disseminated Intravascular Coagulation Immediately After Trauma Predicts a Poor Prognosis in Severely Injured Patients

2021 ◽  
Author(s):  
Takeshi Wada ◽  
Atsushi Shiraishi ◽  
Satoshi Gando ◽  
Kazuma Yamakawa ◽  
Seitaro Fujishima ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Survival Probability ◽  
Poor Prognosis ◽  
Massive Transfusion ◽  
Late Phase ◽  
Hospital Death ◽  
Trauma Patients ◽  
Severely Injured ◽  
Cross Sectional ◽  
Intravascular Coagulation

Abstract 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.

Disseminated Intravascular Coagulation Immediately after Trauma Predicts a Poor Prognosis in Severely Injured Patients: A Sub-analysis of a Multicenter Prospective Study on Disseminated Intravascular Coagulation in Trauma

2020 ◽  
Author(s):  
Takeshi Wada ◽  
Atsushi Shiraishi ◽  
Satoshi Gando ◽  
Kazuma Yamakawa ◽  
Seitaro Fujishima ◽  
...  
Keyword(s):  
Organ Dysfunction ◽  
Disseminated Intravascular Coagulation ◽  
Survival Probability ◽  
Poor Prognosis ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Hospital Death ◽  
Trauma Patients ◽  
Severely Injured ◽  
Intravascular Coagulation

Abstract Background: Trauma patients die from massive bleeding due to 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 MODS and a consequent poor outcome. The aim of this study is to evaluate the effect of a disseminated intravascular coagulation (DIC) diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, multiple organ dysfunction syndrome (MODS), and hospital death in severely injured trauma patients.Methods: Severely injured adult patients (Injury Severity Score >16) were prospectively evaluated for their DIC scores and molecular markers of coagulation and fibrinolysis immediately after emergency department presentation (0 h) and 3 h after admission. Organ dysfunction was assessed by the sequential organ failure assessment (SOFA) score at 24 h after admission. The performance of DIC scores in predicting massive transfusion, MODS, and hospital death, and the effect of a DIC diagnosis on the survival probability were investigated.Results: The 276 enrolled patients included 121 DIC and 155 non-DIC patients. DIC patients showed larger transfusion volume and higher SOFA scores than non-DIC patients at 24 h after admission. 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 higher mortality rate than no such diagnosis. DIC scores at 0 h and 3 h predicted massive transfusion, MODS, and hospital death with significance (all areas under the receiver operating characteristic curves, p<0.001). Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items.Conclusions: 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.Trial registration: UMIN-CTR, UMIN000019588. Registered on 16 November 2015.

424 A SIMPLE DISSEMINATED INTRAVASCULAR COAGULATION SCORE PREDICTS OUTCOME IN TRAUMA PATIENTS

2005 ◽  
Vol 53 (1) ◽  
pp. S328.6-S328
Author(s):  
J. Zein ◽  
E. Chbeir ◽  
R. Albrecht ◽  
C. Castle ◽  
F. B. Taylor ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Trauma Patients ◽  
Intravascular Coagulation

Significant Correlations between Tissue Factor and Thrombin Markers in Trauma and Septic Patients with Disseminated Intravascular Coagulation

1998 ◽  
Vol 79 (06) ◽  
pp. 1111-1115 ◽  
Author(s):  
Satoshi Nanzaki ◽  
Shigeyuki Sasaki ◽  
Osamu Kemmotsu ◽  
Satoshi Gando
Keyword(s):  
Tissue Factor ◽  
Disseminated Intravascular Coagulation ◽  
Thrombin Generation ◽  
Trauma Patients ◽  
Elevated Plasma ◽  
Antigen Concentration ◽  
Intravascular Coagulation ◽  
Factor Antigen ◽  
D Dimer

SummaryTo determine the role of plasma tissue factor on disseminated intravascular coagulation (DIC) in trauma and septic patients, and also to investigate the relationships between tissue factor and various thrombin markers, we made a prospective cohort study. Forty trauma patients and 20 patients with sepsis were classified into subgroups according to the complication of DIC. Plasma tissue factor antigen concentration (tissue factor), prothrombin fragment F1+2 (PF1+2), thrombin antithrombin complex (TAT), fibrinopeptide A (FPA), and D-dimer were measured on the day of admission (day 0), and on days 1, 2, 3, and 4 after admission. The levels of plasma tissue factor in the DIC group were more elevated than those of the non-DIC group in both the trauma and the septic patients. In patients with sepsis, tissue factor levels on days 0 through 4 in the non-DIC group showed markedly higher values than those in the control patients (135 ± 8 pg/ml). Significant correlations between tissue factor and PF1+2, TAT, FPA, and D-dimer were observed in the DIC patients, however, no such correlations were found in the non-DIC patients. These results suggest that elevated plasma tissue factor in patients with trauma and sepsis gives rise to thrombin generation, followed by intravascular coagulation.

Disseminated Intravascular Coagulation (DIC) at an Early Phase of Trauma Continuously Proceeds to DIC at a Late Phase of Trauma

2012 ◽  
Vol 18 (4) ◽  
pp. 364-369 ◽  
Author(s):  
Hiromoto Murakami ◽  
Satoshi Gando ◽  
Mineji Hayakawa ◽  
Atsushi Sawamura ◽  
Masahiro Sugano ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Early Phase ◽  
Late Phase ◽  
Intravascular Coagulation

Clinical course and outcome of disseminated intravascular coagulation diagnosed by Japanese Association for Acute Medicine criteria

2008 ◽  
Vol 100 (12) ◽  
pp. 1099-1105 ◽  
Author(s):  
Satoshi Gando ◽  
Daizoh Saitoh ◽  
Hiroshi Ogura ◽  
Toshihiko Mayumi ◽  
Kazuhide Koseki ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Clinical Course ◽  
Trauma Patients ◽  
Acute Medicine ◽  
Japanese Association ◽  
Intravascular Coagulation ◽  
Coagulation Abnormalities ◽  
Failure Assessment ◽  
Jaam Criteria ◽  
Prothrombin Time Ratio

SummaryThe Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) study group recently announced new diagnostic criteria for DIC. These criteria have been prospectively validated and demonstrated to progress to overt DIC as defined by the International Society on Thrombosis and Haemostasis (ISTH).Although an underlying condition is essential for the development of DIC, it has never been clarified if patients with different underlying disorders have a similar course. Among 329 patients with DIC diagnosed by the JAAM criteria, those with underlying sepsis (n=98) or trauma (n=95) were compared. The 28-day mortality rate was significantly higher in sepsis patients than trauma patients (34.7% vs. 10.5%, p<0.0001).Within three days of fulfilling the JAAM criteria, sepsis patients had a lower platelet count, higher prothrombin time ratio, higher systemic inflammatory response syndrome score, and higher Sequential Organ Failure Assessment score compared with trauma patients. On day 3, a significantly higher percentage of trauma patients than sepsis patients showed improvement of DIC (64.2% vs. 30.6%, p<0.001).These differences were mainly due to patients with lower JAAM DIC scores. More than 50% of the JAAM DIC patients with sepsis who died within 28 days could not be detected by ISTH DIC criteria during the initial three days. In contrast, most trauma patients who died within 28 days had DIC simultaneously diagnosed by JAAM and ISTH criteria, except for those with brain death. These findings suggest that coagulation abnormalities, organ dysfunction, and the outcome of JAAM DIC differ between patients with sepsis and trauma.

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