Prognostic Value of Non-Overt DIC Criteria in Patients with Sepsis.

DIC is a frequent complication of sepsis resulted in high mortality. The early diagnosis of DIC in septic patients is necessary to reduce the mortality by the prevention of irreversible organ damage through earlier therapeutic intervention. We investigated the performance of the ISTH non-overt DIC criteria and its modification by adding antithrombin (AT), protein C and Organ Failure Scoring (OFS) system for mortality prediction were evaluated in 100 septic patients prospectively enrolled between July 2004 and March 2006. Platelet count, PT, aPTT, fibrinogen, D-dimer, AT, protein C on day 0,1,2,3,4, and 7 were measured in each patient. ISTH overt and non-overt DIC scoring with 28-day mortality, OFS was evaluated to assess the diagnostic value of each criterion in the prediction of clinical outcome. Twenty-five, 14 and 61 had overt DIC, non-overt DIC and non-DIC respectively. Platelet count, PT, AT, protein C levels were significantly different between DIC and non-DIC. D-dimer and protein C levels were significantly different between overt and non-overt DIC. The 28-day mortality rate of overt DIC, non-overt DIC and non-DIC was 44, 50 and 11.5% respectively. By adding AT and protein C on non-overt DIC criteria, the 28-day mortality rate of overt DIC, non-overt DIC and non-DIC became changed to 44, 31.4 and 7.5% respectively, but there was no difference between overt and non-overt DIC patients. Addition of AT, protein C or OFS to ISTH non-overt DIC criteria did not improve the diagnostic power significantly. In conclusion, ISTH non-overt DIC criteria is feasible to predict the poor outcome of septic patients.