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CC BY-NC-ND 4.0 · Thromb Haemost
DOI: 10.1055/s-0044-1786808
Coagulation and Fibrinolysis

Proposal and Validation of a Clinically Relevant Modification of the Japanese Association for Acute Medicine Disseminated Intravascular Coagulation Diagnostic Criteria for Sepsis

Kazuma Yamakawa 
1   Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
,
Yutaka Umemura
2   Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
,
Katsunori Mochizuki
1   Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
3   Department of Emergency and Critical Care Medicine, Azumino Red Cross Hospital, Nagano, Japan
,
Tadashi Matsuoka
4   Department of Emergency and Critical Care Medicine, Keio University, Tokyo, Japan
,
Takeshi Wada 
5   Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
,
Mineji Hayakawa
5   Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
,
Toshiaki Iba 
6   Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
,
Yasuhiro Ohtomo
7   National Disaster Medical Center, Tokyo, Japan
,
Kohji Okamoto
8   Department of Surgery, Kitakyushu City Yahata Hospital, Kitakyushu, Japan
,
Toshihiko Mayumi
9   Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
,
Toshiaki Ikeda
10   Division of Critical Care and Emergency Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
,
Hiroyasu Ishikura
11   Department of Emergency and Critical Care Medicine, Fukuoka University, Fukuoka, Japan
,
Hiroshi Ogura
12   Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
,
Shigeki Kushimoto
13   Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
,
Daizoh Saitoh
14   Graduate School of Emergency Medical System, Kokushikan University, Tama, Japan
,
Satoshi Gando
5   Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
15   Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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Abstract

Background Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria were launched nearly 20 years ago. Following the revised conceptual definition of sepsis and subsequent omission of systemic inflammatory response syndrome (SIRS) score from the latest sepsis diagnostic criteria, we omitted the SIRS score and proposed a modified version of JAAM DIC criteria, the JAAM-2 DIC criteria.

Objectives To validate and compare performance between new JAAM-2 DIC criteria and conventional JAAM DIC criteria for sepsis.

Methods We used three datasets containing adult sepsis patients from a multicenter nationwide Japanese cohort study (J-septic DIC, FORECAST, and SPICE-ICU registries). JAAM-2 DIC criteria omitted the SIRS score and set the cutoff value at ≥3 points. Receiver operating characteristic (ROC) analyses were performed between the two DIC criteria to evaluate prognostic value. Associations between in-hospital mortality and anticoagulant therapy according to DIC status were analyzed using propensity score weighting to compare significance of the criteria in determining introduction of anticoagulants against sepsis.

Results Final study cohorts of the datasets included 2,154, 1,065, and 608 sepsis patients, respectively. ROC analysis revealed that curves for both JAAM and JAAM-2 DIC criteria as predictors of in-hospital mortality were almost consistent. Survival curves for the anticoagulant and control groups in the propensity score-weighted prediction model diagnosed using the two criteria were also almost entirely consistent.

Conclusion JAAM-2 DIC criteria were equivalent to JAAM DIC criteria regarding prognostic and diagnostic values for initiating anticoagulation. The newly proposed JAAM-2 DIC criteria could be potentially alternative criteria for sepsis management.

Keywords

anticoagulant - coagulopathy - diagnostic criteria - DIC - sepsis

Ethical Approval statement

The study protocol was approved by the Institutional Review Board of the Osaka General Medical Center (approval numbers: #25–2050, #30-S11–004, and #S201901009). Informed consent was waived due to the nature of the registries.


Authors' Contribution

K.Y. and T.I. conceived and designed this study. K.Y. contributed to acquisition, analysis, and interpretation of the data and was responsible for drafting, editing, and submission of the manuscript. Y.U. contributed to acquisition, analysis, interpretation of the data, and drafting of the manuscript. K.M., T.M., T.W., and M.H. played a significant role in the analysis of the data and helped to draft the manuscript. T.I., Y.O., K.O., T.M., T.I., H.I., H.O., S.K., D.S., and S.G. had a significant influence on the interpretation of the data and critical appraisal of the manuscript. All of the authors contributed to the acquisition of data and reviewed, discussed, and approved the final manuscript.


Supplementary Material



Publication History

Received: 12 October 2023

Accepted: 02 April 2024

Article published online:
10 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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