Mycobacterium tuberculosis inducing disseminated intravascular coagulation

2005 ◽  
Vol 93 (04) ◽  
pp. 729-734 ◽  
Author(s):  
Jann-Yuan Wang ◽  
Po-Ren Hsueh ◽  
Yuang-Shuang Liaw ◽  
Wen-Yi Shau ◽  
Pan-Chyr Yang ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Clinical Manifestation ◽  
Disseminated Intravascular Coagulation ◽  
Early Stage ◽  
Prognostic Significance ◽  
Clinical Manifestations ◽  
Clinical Findings ◽  
Mediastinal Lymphadenopathy ◽  
Disseminated Tuberculosis ◽  
Intravascular Coagulation

SummaryDisseminated intravascular coagulation (DIC) can develop infrequently in patients with tuberculosis and has a very high mortality rate. We conducted a retrospective study to evaluate the incidence of tuberculosis-induced DIC and to investigate the clinical manifestation, outcome, and prognostic factors of such patients. From January 2002 to December 2003, all culture-proven tuberculosis patients who developed DIC before starting anti-tuberculosis treatments were selected for this study. Patients who had other clinical conditions or were infected by other pathogens that may have been responsible for their DIC were excluded. Survival analysis was performed for each variable with possible prognostic significance. Our results showed that 27 (3.2%) out of the 833 patients with culture-proven tuberculosis had tuberculosis-induced DIC with a mortality rate of 63.0%. The most common clinical manifestations were fever (63.0%) and multiple patches of pulmonary consolidation (59.3%). Seven (25.9%) patients had disseminated tuberculosis. Twelve (44.4%) developed acute respiratory distress syndrome and three (11.1%) were associated with hemophagocytosis. Twenty-four (88.9%) patients had findings that were unusual for an acute bacterial infection, such as positive acid-fast smear, miliary pulmonary lesions, lymphocytotic exudative pleural effusion, and mediastinal lymphadenopathy. Early anti-tuberculosis treatment significantly improved survival. In conclusion, tuberculosis can cause DIC. Patients with non-miliary, non-disseminated tuberculosis could also develop the rare clinical manifestation. Since the prognosis was very poor in patients not treated at an early stage, a high index of suspicion is required, especially in those with clinical findings suggestive of tuberculosis.

Disseminated intravascular coagulation syndrome

2020 ◽  
pp. 22-40
Author(s):  
A. Kulikov
Keyword(s):  
Clinical Practice ◽  
Disseminated Intravascular Coagulation ◽  
Blood Cells ◽  
Physical State ◽  
Clinical Manifestations ◽  
Vascular Wall ◽  
Stages Of Development ◽  
Intravascular Coagulation ◽  
Hemostatic Disorder

Presented material reveals main links in the pathogenesis of hemostatic disorder. In particular, attention is paid to the role of the lungs, liver and other organs in the development of this process. Role of vascular wall and blood cells in regulation of the physical state of blood is described in detail. The most frequent factors leading to hypercoagulation are indicated. Difference between hypercoagulation and thrombophilia is shown. The latter is found in clinical practice quite often, but at the same time, it is poorly diagnosed. Such a terrible complication of hemostatic disorder as disseminated intravascular coagulation is described. Its classification, stages of development, clinical manifestations are offered to the readers.

scholarly journals Epidemiology and Factors Affecting Mortality of Hospitalized Patients with Disseminated Intravascular Coagulation in the United States

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2404-2404
Author(s):  
Arya Mariam Roy ◽  
Manojna Konda ◽  
Akshay Goel ◽  
Appalanaidu Sasapu
Keyword(s):  
United States ◽  
African Americans ◽  
Native Americans ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Disseminated Intravascular Coagulation ◽  
The United States ◽  
Hospitalized Patients ◽  
Northeast Region ◽  
Intravascular Coagulation

Introduction Disseminated Intravascular Coagulation (DIC) is a systemic coagulopathy which leads to widespread thrombosis and hemorrhage and ultimately results in multiorgan dysfunction. DIC usually occurs as a complication of illnesses like severe sepsis, malignancies, trauma, acute pancreatitis, burns, and obstetrical complications. The prognosis and mortality of DIC depend on the etiology, however, the mortality of DIC is known to be on the higher side. The aim of the study is to analyze if gender, race, regional differences have any association with the mortality of hospitalized patients with DIC. Method The National Inpatient Sample database from the Healthcare Cost and Utilization Project (HCUP) for the year 2016 was queried for data. We identified hospital admissions for DIC with the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code D65. The data was analyzed with STATA 16.0 version and univariate and multivariate analysis were performed. We studied the characteristics of all such hospitalizations for the year 2016 and the factors associated with the in-hospital mortality rate (MR) of DIC. We used length of stay, cost of stay as an outcome to determine if gender, race, and location play a role in the mortality. Results A total of 8704 admissions were identified with a diagnosis of DIC during the year 2016. The mean age for admission was found to be 56.48± 0.22. The percentage of admissions in females and males did not have a notable difference (50.57% vs 49.43%). The disease specific MR for DIC was 47.7%. Admission during weekend vs weekdays did not carry a statistically significant difference in terms of MR. Females with DIC were less likely to die in the hospital when compared to males with DIC (OR= 0.906, CI 0.82 - 0.99, p= 0.031). Interestingly, African Americans (AA) with DIC admissions were found to have 24% more risk of dying when compared to Caucasians admitted with DIC (OR= 1.24, CI 1.10 - 1.39, P= 0.00), Native Americans (NA) has 67% more risk of dying when compared to Caucasians (OR= 1.67, CI 1.03 - 2.69, p= 0.035). The mortality rate of NA, AA, Caucasians with DIC was found to be 57%, 52%, 47% respectively. The MR was found to be highest in hospitals of the northeast region (52%), then hospitals in the south (47%), followed by west and mid-west (46%), p= 0.000. Patients admitted to west and mid-west were 24% less likely to die when compared to patients admitted to northeast region hospitals (OR= 0.76, p= 0.001). The average length of stay and cost of stay were also less in west and mid-west regions when compared to north east. The difference in outcomes persisted after adjusting for age, gender, race, hospital division, co-morbid conditions. Conclusion Our study demonstrated that African Americans and Native Americans with DIC have high risk of dying in the hospital. Also, there exists a difference between the mortality rate, length and cost of stay among different regions in the United States. More research is needed to elucidate the factors that might be impacting the location-based variation in mortality. Disclosures No relevant conflicts of interest to declare.

Disseminated intravascular coagulation in paediatrics

2016 ◽  
Vol 102 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Revathi Rajagopal ◽  
Jecko Thachil ◽  
Paul Monagle
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Diagnostic Tests ◽  
Early Life ◽  
Clinical Manifestations ◽  
Review Article ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Intravascular Coagulation ◽  
Management Algorithm ◽  
Recent Advances

Disseminated intravascular coagulation (DIC) in paediatrics is associated with significant morbidity and mortality. Although there have been several recent advances in the pathophysiology of DIC, most of these studies were done in adults. Since the haemostatic system is very different in early life and changes dramatically with age, creating a variety of challenges for the clinician, delay in the diagnosis of DIC can happen until overt DIC is evident. In this review article, we report the aetiology, pathophysiology, clinical manifestations, diagnostic tests and a management algorithm to guide paediatricians when treating patients with DIC.

scholarly journals Mortalidad por aborto séptico en el Hospital Nacional Cayetano Heredia. 1985 - 1992

2015 ◽  
Vol 40 (1) ◽  
pp. 55-59
Author(s):  
Raúl Castro ◽  
Eduardo Maradiegue
Keyword(s):  
Septic Shock ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Mortality Rate ◽  
Disseminated Intravascular Coagulation ◽  
Control Group ◽  
Uterine Perforation ◽  
Intravascular Coagulation ◽  
Foul Odor ◽  
Septic Abortion

This is a retrospective epidemiological control case type study of twenty-four deaths caused by septic abortion attended at our Hospital from 1985 through 1992. Control group consisted of 72 pregnant women who survived.. Septic abortion mortality rate was 67,3 per 100000 live newborns. Highest rate, 176,6, occurred in 1991. Mortality rate factor were 5 or more pregnancies (OR=1,7), gestational age over 16 week (OR=5,0), time from abortion maneuvers over 5 days (OR=1,7), septic shock (OR=8,5), anemia (OR=3,4), acute renal failure (OR=17,0), uterine perforation (OR=3,4), disseminated intravascular coagulation (OR=60,0), pelvic thrombophlebitis (OR = 10,2), multisystemic failure (OR=6,5) and lung shock (OR = 6,5). Significant symptoms were yellowish foul odor discharge, jaundice, petechiae, disnea and muscular pain. Main medical and surgical treatment consisted in blood and plasma transfusions, cardiotonics and anticoagulation, and hysterectomy and bilateral salpingoophorectomy. Main causes of death, were septic shock, acute renal failure, multisystemic failure, disseminated intravascular coagulation and lung thromboembolism.

Disseminated Intravascular Coagulation and Acute Renal Failure

1971 ◽  
Vol 26 (02) ◽  
pp. 332-340 ◽  
Author(s):  
I Crîsnic ◽  
M Cucuianu ◽  
M Manasia ◽  
G Uza
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Disseminated Intravascular Coagulation ◽  
Early Stage ◽  
Platelet Adhesiveness ◽  
Intravascular Coagulation ◽  
Clinical Observations ◽  
Lysis Time ◽  
Euglobulin Lysis Time

SummaryStarting from a hypothesis according to which disseminated intravascular coagulation might be an intermediary mechanism in the production of acute renal failure, investigations were made in 94 cases of anuria of different etiology, in order to detect signs of a consumption coagulopathy. After an average lapse of time of 48 h since the onset of anuria, the most frequently encountered hemostatic defect was a decreased platelet adhesiveness. In vitro experiments and clinical observations suggest that in the early stage of acute renal failure caused by a septic abortion, deficient platelet adhesiveness is due, mainly to platelet damage caused by intravascular coagulation or by bacterial toxins and not by the retention of metabolites. Euglobulin lysis time was prolonged, but a significant decrease of the plasminogen level indicates that an activation of fibrinolysis might have occured in the evolution of the process.

Efficacy and Safety of Recombinant Human Soluble Thrombomodulin (ART-123) in Disseminated Intravascular Coagulation (DIC): Results of Phase III Randomized, Double-Blind, Clinical Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 576-576
Author(s):  
Hidehiko Saito ◽  
Ikuro Maruyama ◽  
Shuji Shimazaki ◽  
Yasuhiro Yamamoto ◽  
Naoki Aikawa ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Disseminated Intravascular Coagulation ◽  
Clinical Course ◽  
Efficacy And Safety ◽  
Heparin Group ◽  
Double Blind ◽  
Soluble Thrombomodulin ◽  
Intravascular Coagulation ◽  
Recombinant Human Soluble Thrombomodulin

Abstract Background: Thrombomodulin is a thrombin receptor on the endothelial cell surface that plays an important role in the regulation of intravascular coagulation. Recombinant human soluble thrombomodulin (ART-123) is composed of the active, extracellular domain of thrombomodulin. ART-123 has been shown to have a wider safety margin than other anticoagulants and to have a favorable antithrombotic profile with less bleeding in animal and in vitro experiments. ART-123 is a promising therapeutic natural anticoagulant that is comparable to antithrombin, tissue factor pathway inhibitor and activated protein C. Objective: We conducted a multicenter, double-blind, randomized parallel-group trial to compare the efficacy and safety of ART-123 to those of heparin for the treatment of disseminated intravascular coagulation (DIC) associated with infection or hematologic malignancy. Methods: DIC was diagnosed according to the diagnostic criteria established by the Japanese Ministry of Health and Welfare. DIC patients were assigned to receive ART-123 (0.06 mg/kg for 30 min, once a day) or heparin sodium (8 units/kg/h for 24 h) for six days using a double dummy method. The primary efficacy endpoint was DIC resolution rate (rate of recovery from DIC). The secondary endpoints included clinical course of bleeding symptoms, and mortality at 28 days. Results: 234 DIC patients were randomized (117 in each arm). DIC resolution rate was 66.1% for the ART-123 group and 49.9% for the heparin group (difference 16.2%; 95% CI 3.3–29.1), thus demonstrating that ART-123 is significantly superior to heparin for the improvement of DIC. Patients in the ART-123 group also showed more marked improvement in clinical course of bleeding symptoms (p=0.0271) and the disappearance rate of bleeding symptoms in the ART-123 group was higher than that in the heparin group (35.2% vs 20.9%; difference 14.3%). The incidence of bleeding-related adverse events up to 7 days after the start of administration was lower in the ART-123 group than in the heparin group (43.1% vs 56.5%; difference; −13.4%; p=0.0487). The mortality rate at 28 days in the ART-123 group was 22.0% vs 25.5% in the heparin group (difference −3.4%; p=0.5396). Although no significant differences were seen, 28-day mortality for the ART-123 group was slightly lower. The mortality rate of patients with DIC secondary to infection in the ART-123 and heparin groups was 28.0% (14/50) and 34.6% (18/52), respectively, indicating a 6.6% lower mortality in the ART-123 group. Conclusion: When compared with low-dose heparin, ART-123 more significantly improves DIC and alleviates bleeding symptoms in DIC patients. The incidence of bleeding-related adverse events is significantly lower with ART-123 than with heparin. Because of its safety and efficacy, ART-123 appears to be a first-line agent in the management of DIC.

Systemic Inflammation and Disseminated Intravascular Coagulation in Early Stage of ALI and ARDS: Role of Neutrophil and Endothelial Activation

Inflammation ◽  
2004 ◽  
Vol 28 (4) ◽  
pp. 237-244 ◽  
Author(s):  
Satoshi Gando ◽  
Takashi Kameue ◽  
Naoyuki Matsuda ◽  
Atsushi Sawamura ◽  
Mineji Hayakawa ◽  
...  
Keyword(s):  
Systemic Inflammation ◽  
Disseminated Intravascular Coagulation ◽  
Early Stage ◽  
Endothelial Activation ◽  
Intravascular Coagulation
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