Abstract
Background Septic-associated disseminated intravascular coagulation (DIC) is heterogeneous regarding
prognosis and responsiveness to anticoagulant therapy.
Objectives To investigate the relationship between the timing of development and recovery of
DIC, its prognosis, and the difference in response to anticoagulant therapy in sepsis-associated
DIC patients.
Methods This study was performed with a dataset from a multicenter nationwide retrospective
cohort study (J-Septic DIC registry) in Japan between 2011 and 2013 to reveal the
subgroup “high risk of death in DIC” and investigate the relationship between anticoagulant
use and mortality. Patients were assigned to four groups based on the International
Society on Thrombosis and Haemostasis-overt DIC status at days 1 and 3: non-DIC (−/−),
early-recovered DIC (+/−), late-onset DIC (−/+), and persistent DIC (+/+).
Results A total of 1,922 patients were included. In-hospital mortality in persistent and
late-onset DIC patients was significantly higher than in patients with non-DIC and
early-recovered DIC. This finding indicates that persistent DIC and late-onset DIC
were a poor-prognosis subgroup, “high-risk” DIC. Meanwhile, patients with high-risk
DIC treated with anticoagulants had significantly better outcomes than those without
anticoagulants after adjusting for confounding factors.
Conclusion This study showed that individuals with a high risk of death, persistent DIC, and
late-onset DIC were a poor-prognostic subgroup in septic DIC; however, high-risk DIC
is also a subgroup that can obtain more benefits from anticoagulant therapy.
Keywords
disseminated intravascular coagulation - sepsis - anticoagulant therapy
