Predictors of Disseminated Intravascular Coagulation in Patients with Septic Shock

Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, ). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC ( ). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC ( ). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay. 1. Introduction Sepsis is the leading cause of mortality in noncardiac ICU admissions [1]. The reported incidence of septic shock ranges from 6.3% to 14.7% [2]. Based on the landmark study by Rivers et al., early aggressive resuscitation guided by continuous central venous oxygen saturation (ScvO2), central venous pressure (CVP), and mean arterial pressure (MAP) monitoring reduced both in-hospital mortality rates from 56.8% to 42.3% and 28-day mortality rates from 46.5% to 30.5% [3]. Disseminated intravascular coagulation (DIC) is commonly seen in septic patients and is associated with an increased rate of morbidity and mortality [4]. DIC is defined by the International Society of Thrombosis and Hemostasis (ISTH) as “an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes. It can originate from and cause damage to the microvasculature. When sufficiently severe, it can produce organ dysfunction” [5]. In 2001, the DIC subcommittee of the ISTH developed a DIC score since it is essentially a clinical diagnosis based on laboratory assays, specifically low platelet count, elevated fibrin-related markers (soluble fibrin monomers or fibrin degradation products), elevated prothrombin time, and low fibrinogen level [5]. The diagnosis of overt DIC based on an ISTH DIC