Disseminated Intravascular Coagulopathy (DIC) Score in Critically Ill Patients and its Impact on Prognosis

Objectives: To study the correlation between the incidence of Dissiminated Intravscular Coagulopathy (DIC) in critically ill patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 25 and the incidence and outcome of Multi-Organ Dysfunction Syndrome (MODS),and to investigate the relation between DIC and increasing mortality.Design: A prospective, randomized, cohort, non-controlled, single center study.Setting: Medical and Surgical Intensive Care Units (ICU s) of Critical Care Department in Kasr-Alainy Hospital of Cairo University.Patients: Fifty critically ill patients with APACHE II score ≥25, not including those with disseminated malignancies, chronic liver cell, renal failure or chronic hematological disorders.Intervention: All included patients were subjected to informed consent, detailed history taking, careful physical examination, Laboratory investigations; including: Routine lab tests, Serum Fibrinogen and quantitative D-dimer levels.Measurements: For all included patients with APACHE II score ≥ 25 on admission, DIC and Sequential Organ Failure Assessment (SOFA) scores were calculated at baseline (on ICU admission) and subsequently thereafter every 48 hours until ICU discharge or death or up to a total of 28 days. Clinical outcome (duration of stay in the ICU, need for mechanical ventilation, need for inotropic/vasopressor therapy, need for Renal replacement therapy (RRT), and final outcome of survival/mortality rates) were recorded.Results: Through comparison between patients who improved or survived and patients who died at day 28; there was a significant variance between both groups in terms of SOFA score at day 2, day 4 and upon discharge (5.61±2.004 vs 7.69±2.901, p-value 0.01, 4.28±1.526 vs 8.97±3.578, p-value 0.001, and 3.17±1.543 vs 11.69±3.514, p-value 0.001 respectively), DIC score at day 2, day 4 and upon discharge (2.83±0.985 vs 3.59±0.946, p-value 0.01, 2.67±0.907 vs 3.91±1.174 , p-value 0.001, and 2.33±1.085 vs 4.34±1.004, p-value 0.001 respectively), we found good correlation between DIC scores SOFA scores at day 0,2,4 and at discharge (p-values: 0.001, 0.001, 0.001 0.001 respectively). There was good correlation between DIC scores at day 4 at discharge patient s outcome (p-value 0.001 0.001 respectively).Conclusion: There was a strong correlation between SOFA and DIC scores in critically ill patients with APACHE II score ≥ 25 as regards MODS and mortality.