Role of disseminated intravascular coagulation in severe sepsis

被引：90

作者：

Gando, Satoshi ^{[1
,85
]}

Shiraishi, Atsushi ^{[2
,65
]}

Yamakawaka, Kazuma ^{[3
,80
]}

Ogura, Hiroshi ^{[4
,64
]}

Saitoh, Daizoh ^{[5
,67
]}

Fujishima, Seitaro ^{[6
,68
]}

Mayumi, Toshihiko ^{[7
,69
]}

Kushimoto, Shigeki ^{[8
,66
]}

Abe, Toshikazu ^{[9
,63
]}

Shiino, Yasukazu ^{[10
,70
]}

Nakada, Taka-aki ^{[11
,71
]}

Tarui, Takehiko ^{[12
,72
]}

Hifumi, Toru ^{[13
,73
]}

Otomo, Yasuhiro ^{[14
,74
]}

Okamoto, Kohji ^{[15
]}

Umemura, Yutaka ^{[4
,64
]}

Kotani, Joji ^{[16
,75
]}

Sakamoto, Yuichiro ^{[17
,76
]}

Sasaki, Junichi ^{[18
,68
]}

Shiraishi, Shin-ichiro ^{[19
,77
]}

Takuma, Kiyotsugu ^{[20
,78
]}

Tsuruta, Ryosuke ^{[21
,79
]}

Hagiwara, Akiyoshi ^{[22
]}

Masuno, Tomohiko ^{[23
]}

Takeyama, Naoshi ^{[24
,81
]}

Yamashita, Norio ^{[25
,82
]}

Ikeda, Hiroto ^{[26
,83
]}

Ueyama, Masashi ^{[27
]}

Fujimi, Satoshi ^{[3
]}

Tasaki, Osamu ^{[28
]}

Mizobata, Yasumitsu ^{[29
]}

Funakoshi, Hiraku ^{[30
]}

Okuyama, Toshiro ^{[31
]}

Yamashita, Iwao ^{[32
]}

Kanai, Toshio ^{[33
]}

Yamada, Yasuo ^{[34
]}

Aibiki, Mayuki ^{[35
]}

Sato, Keiji ^{[36
]}

Yamashita, Susumu ^{[37
,38
]}

Yoshida, Kenichi ^{[39
]}

Kasaoka, Shunji ^{[40
]}

Kon, Akihide ^{[41
]}

Rinka, Hiroshi ^{[42
]}

Kato, Hiroshi ^{[43
]}

Okudera, Hiroshi ^{[44
]}

Narimatsu, Eichi ^{[45
]}

Fujiwara, Toshifumi ^{[46
]}

Sugita, Manabu ^{[47
]}

Shichinohe, Yasuo ^{[48
]}

Nakae, Hajime ^{[49
]}

机构：

[1] Hokkaido Univ, Grad Sch Med, Dept Anesthesiol & Crit Med, Dept Acute & Crit Care Med,Sapporo Higashi Tokush, Sapporo, Hokkaido, Japan

[2] Kameda Med Ctr, Emergency & Trauma Ctr, Kamogawa, Japan

[3] Osaka Gen Med Ctr, Div Trauma & Surg Crit Care, Osaka, Japan

[4] Osaka Univ, Grad Sch Med, Dept Traumatol & Acute Crit Med, Suita, Osaka, Japan

[5] Natl Def Med Coll, Res Inst, Div Traumatol, Tokorozawa, Saitama, Japan

[6] Keio Univ, Sch Med, Ctr Gen Med Educ, Tokyo, Japan

[7] Univ Occupat & Environm Hlth, Sch Med, Dept Emergency Med, Kitakyushu, Fukuoka, Japan

[8] Tohoku Univ, Grad Sch Med, Div Emergency & Crit Care Med, Sendai, Miyagi, Japan

[9] Univ Tsukuba, Hlth Serv Res & Dev Ctr, Juntendo Univ, Dept Gen Med, Tsukuba, Ibaraki, Japan

[10] Kawasaki Med Sch, Dept Acute Med, Kawasaki, Kanagawa, Japan

[11] Chiba Univ, Grad Sch Med, Dept Emergency & Crit Care Med, Chiba, Japan

[12] Kyorin Univ, Sch Med, Dept Trauma & Crit Care Med, Mitaka, Tokyo, Japan

[13] St Lukes Int Hosp, Dept Emergency & Crit Care Med, Tokyo, Japan

[14] Tokyo Med & Dent Univ, Med Hosp, Trauma & Acute Crit Care Ctr, Tokyo, Japan

[15] Kitakyushu City Yahata Hosp, Ctr Gastroenterol & Liver Dis, Dept Surg, Kitakyushu, Fukuoka, Japan

[16] Kobe Univ, Grad Sch Med, Dept Surg Related, Div Disaster & Emergency Med, Kobe, Hyogo, Japan

[17] Saga Univ Hosp, Emergency & Crit Care Med, Saga, Japan

[18] Keio Univ, Sch Med, Dept Emergency & Crit Care Med, Tokyo, Japan

[19] Aizu Chuo Hosp, Dept Emergency & Crit Care Med, Aizu Wakamatsu, Fukushima, Japan

[20] Kawasaki Municipal Kawasaki Hosp, Emergency & Crit Care Ctr, Kawasaki, Kanagawa, Japan

[21] Yamaguchi Univ, Adv Med Emergency & Crit Care Ctr, Ube, Yamaguchi, Japan

[22] Natl Ctr Global Hlth & Med, Ctr Hosp, Tokyo, Japan

[23] Nippon Med Sch, Dept Emergency & Crit Care Med, Tokyo, Japan

[24] Aichi Med Univ Hosp, Adv Crit Care Ctr, Nagakute, Aichi, Japan

[25] Kurume Univ Hosp, Adv Emergency Med Serv Ctr, Kurume, Fukuoka, Japan

[26] Teikyo Univ, Sch Med, Dept Emergency Med, Tokyo, Japan

[27] Chukyo Hosp, Japan Community Healthcare Org, Crit Care Med & Burn Ctr, Dept Trauma, Nagoya, Aichi, Japan

[28] Nagasaki Univ Hosp, Nagasaki, Japan

[29] Osaka City Univ Hosp, Osaka, Japan

[30] Tokyobay Urayasu Ichikawa Med Ctr, Urayasu, Japan

[31] Aso Iizuka Hosp, Iizuka, Fukuoka, Japan

[32] Tomei Atsugi Hosp, Atsugi, Kanagawa, Japan

[33] Hiratsuka City Hosp, Hiratsuka, Kanagawa, Japan

[34] Natl Hosp Org Sendai Med Ctr, Sendai, Miyagi, Japan

[35] Ehime Univ Hosp, Toon, Japan

[36] Okayama Univ Hosp, Okayama, Japan

[37] Tokuyama Cent Hosp, Shunan, Japan

[38] Fukuyama City Hosp, Fukuyama, Hiroshima, Japan

[39] JA Hiroshima Gen Hosp, Hatsukaichi, Japan

[40] Kumamoto Univ Hosp, Kumamoto, Japan

[41] Hachinohe Municipal Hosp, Hachinohe, Aomori, Japan

[42] Osaka City Gen Hosp, Osaka, Japan

[43] Natl Hosp Org Disaster Med Ctr, Tachikawa, Tokyo, Japan

[44] Univ Toyama, Toyama, Japan

[45] Sapporo Med Univ, Sapporo, Hokkaido, Japan

[46] Okayama Saiseikai Gen Hosp, Okayama, Japan

[47] Juntendo Univ, Nerima Hosp, Tokyo, Japan

[48] Natl Hosp Org Hokkaido Med Ctr, Sapporo, Hokkaido, Japan

[49] Akita Univ Hosp, Akita, Japan

[50] Japanese Red Cross Soc Kyoto Daini Hosp, Kyoto, Japan

来源：

THROMBOSIS RESEARCH | 2019年 / 178卷

关键词：

Disseminated intravascular coagulation (DIC); Organ dysfunction; Outcome; Sepsis; Septic shock; Severe sepsis; NATURAL-HISTORY; ORGAN FAILURE; DEFINITIONS; EPIDEMIOLOGY;

D O I：

10.1016/j.thromres.2019.04.025

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Disseminated intravascular coagulation (DIC) associated with multiple organ dysfunction syndrome (MODS) plays pivotal roles in severe sepsis. Objectives: We performed a multicenter, prospective data collection study and retrospectively analyzed the data to confirm the role of DIC in severe sepsis. Methods: Eligible patients were ICU patients who met the definitions of severe sepsis, and 1013 patients were included. DIC scores as well as disease severity and the development of MODS on the day of the diagnosis of severe sepsis (day 0) and at day 3 were evaluated. The primary outcome was hospital mortality, and MODS on days 0 and 3 was the secondary outcomes. Results: The overall mortality rate of severe sepsis was 21.5%, and the prevalence of DIC was 50.9% (516/ 1013). DIC patients were more seriously ill and exhibited a higher prevalence of MODS (32.0% vs. 13.1%) on day 0 and worse mortality rate (24,8% vs. 17.5%) than non-DIC patients. DIC patients also showed a lower survival probability than non-DIC patients (Log rank p= 0.028). Logistic regression analyses after propensity score adjustment for potential confounders confirmed a significant association between DIC and MODS and hospital death in the patients with severe sepsis. The new development of DIC and persistent DIC from days 0 to 3 were associated with a high incidence of MODS and low survival probability. Conclusions: The mortality rate of severe sepsis has been improved; however, DIC is still associated with the poor prognosis of these patients. Evaluating the dynamic changes in the DIC status may improve the prediction capability.

引用

页码：182 / 188

页数：7

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