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Thromb Haemost 2022; 122(12): 1980-1987
DOI: 10.1055/a-1925-2300
Coagulation and Fibrinolysis

Disseminated Intravascular Coagulation Score Predicts Mortality in Patients with Liver Disease and Low Fibrinogen Level

Juergen Grafeneder
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
2   Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
,
Nina Buchtele
3   Department of Medicine I - Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
,
Daniel Egger
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Michael Schwameis
2   Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
,
Cihan Ay
4   Division of Haematology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
,
Bernd Jilma
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
,
Christian Schoergenhofer
1   Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Abstract

Background Alongside its original diagnostic intention, the International Society on Thrombosis and Haemostasis' (ISTH) disseminated intravascular coagulation (DIC) score predicts mortality in various patient groups.

Objectives We investigated whether coagulopathy quantified by the DIC score can predict 30-day mortality in patients with liver disease and low fibrinogen levels.

Methods We retrospectively analyzed all patients admitted to the Vienna General Hospital between 2003 and 2014 with a fibrinogen level of <150 mg/dL, a history of liver disease, and ≥2 pathological DIC parameters. We used a Cox regression and receiver operating characteristic analysis to assess the predictive value of the ISTH DIC score in its original (DIC-2001) and revised form (DIC-2018).

Results A total of 1,333 patients were screened, and 388 of these patients (38% female, median age: 58 years, interquartile range: 48–66 years) were analyzed. The DIC-2001 (hazard ratio [HR]: 2.08, 95% confidence interval [CI]: 1.78–2.59, p < 0.001) and DIC-2018 (HR: 1.73, 95% CI: 1.51–2.05, p < 0.001) predicted 30-day mortality. The results remained robust in several sensitivity analyses.

Conclusion The ISTH DIC-2001 and DIC-2018 scores predicted 30-day mortality in patients with liver disease and low fibrinogen levels. The DIC score deserves further investigation in this population as it likely reflects different dimensions of the underlying disease.

Keywords

coagulation - disseminated intravascular coagulation - fibrinogen - liver diseases

Supplementary Material



Publication History

Received: 20 April 2022

Accepted: 06 July 2022

Accepted Manuscript online:
16 August 2022

Article published online:
28 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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