Download PDF
Open Access
CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2802-3753
Original Article: Coagulation and Fibrinolysis

Clinical Heterogeneity and Prognostic Impact of Disseminated Intravascular Coagulation in Critically Ill Patients: A Large-Scale Retrospective Study

Authors

  • Mariko Hayamizu

    1   Emergency and Critical Care Center, Hokkaido University Hospital, Hokkaido University Hospital, Sapporo, Japan

  • Mineji Hayakawa

    2   Department of Emergency and General Medicine, Sapporo City General Hospital, Sapporo, Japan
Further Information
  Permissions and Reprints


Graphical Abstract

Abstract

Background

Disseminated intravascular coagulation (DIC) is a serious condition characterized by systemic coagulation activation leading to thrombotic and hemorrhagic complications. Although the characteristics of DIC vary depending on the underlying cause, studies directly comparing coagulation/fibrinolysis laboratory findings across a wide range of underlying diseases are limited.

Objective

We investigated the characteristics of coagulation/fibrinolysis laboratory results, the frequency of DIC, and the impact of DIC on patient prognosis across various underlying diseases in a critical care setting.

Methods

This was a single-center retrospective observational study of 1,665 critically ill patients admitted between January 1, 2010, and December 21, 2022. Patients were categorized based on underlying diseases, which included out-of-hospital cardiac arrest, sepsis, trauma, burn, and heat stroke. We retrospectively collected data on background, DIC scores, laboratory results, and in-hospital mortality rates of patients.

Results

Significant heterogeneity in coagulation/fibrinolysis laboratory findings was observed, with all findings differing based on the underlying disease (p < 0.001). For example, patients with trauma-associated DIC showed significantly elevated D-dimer and fibrin/fibrinogen degradation product levels, while those with burn-associated DIC tended to have high platelet counts and a rapid decrease in antithrombin activity following admission. Among all underlying diseases, the development of DIC was associated with an increase in in-hospital mortality. This association was particularly strong in patients with trauma or burns.

Conclusion

The coagulation/fibrinolysis laboratory findings, along with the clinical trajectory of DIC, exhibit remarkable heterogeneity depending on the precipitating cause. Development of DIC in patients with burn or trauma is strongly associated with increased in-hospital mortality.

Keywords

disseminated intravascular coagulation - coagulation - critical care - trauma - sepsis

Ethical Approval

This study was approved by the Institutional Review Board of the Ethics Committee of Hokkaido University Hospital (no. 024-0247, approved November 12, 2024) and was conducted in accordance with the Declaration of Helsinki. The need for written informed consent was waived because of the retrospective design of the study.




Publication History

Received: 06 October 2025

Accepted: 31 January 2026

Article published online:
12 February 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany