Disseminated intravascular coagulation. Case series and literature review

Main Article Content

Luis del Carpio-Orantes
Jorge José García-Ortiza

Keywords

Disseminated intravascular coagulation, Intensive care, Severity of illness index

Abstract

Background: Disseminated intravascular coagulation is an entity characterized by activation of the coagulation cascade and endogenous fibrinolysis, which can cause death. Our objectives were to identify the incidence of disseminated intravascular coagulation, its etiologic agents and the correlation between the Apache II score and the one proposed by the International Society on Thrombosis and Haemostasis for the diagnosis of this entity.

Methods: Retrospective, descriptive, observational study of patients treated in an intensive care unit over a 17-month period. Etiology, age, sex, platelet count, coagulation tests, serum fibrinogen levels and D-dimer quantification were analyzed. The score on the scale proposed by the International Society on Thrombosis and Haemostasis and the Apache II score were calculated.

Results: 11 patients (7.18 % of the total number treated subjects at the intensive care unit) had a diagnosis of disseminated intravascular coagulation; six were females. Sepsis was the main etiologic agent (four cases). The most affected age group was the 51-60 years group (four cases). The prognosis was bad in seven subjects. Patients with five points or more in the DIC system, but with a low Apache II score had a good prognosis.

Conclusions: The combination of the DIC and the Apache II scores serves for predicting the outcome of patients with severe organ injuries.

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References

Trejo-García KC, Cuevas-Escamila JE, Villalobos-Silva JA, Montes de Oca-Sandoval M. Coagulación intravascular diseminada (CID) durante el perioperatorio y postoperatorio. Rev Mex Anestesiol. 2013; 36(2):105-13.

 

Fondevila C. Coagulación intravascular diseminada. Rev Argent Hematol. 2012;16(Supl):36-40.

 

Sawamura A. Hayakawa M, Gando S, Kubota N, Sugano M, Wada T. Application of the Japanese Association for Acute Medicine disseminated intravascular coagulation diagnostic criteria for patients at an early phase of trauma. Thromb Res. 2009;124 (6):706-10.

 

Bakhtiari K, Meijers JC, de Jonge E, Levi M. Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation. Crit Care Med. 2004;32(12):2416-21.

 

Quintana-Díaz M, Cabestrero-Alonso D, García-de Lorenzo, Mateos A. Coagulación y hemorragia en el paciente crítico: patrón, pruebas diagnósticas y etiología. Med Intensiva. 2003;27(9):605-14.

 

Angstwurm MW, Dempfle CE, Spannagl, M. New disseminated intravascular coagulation score: A useful tool to predict mortality in comparison with Acute Physiology and Chronic Health Evaluation II and Logistic Organ Dysfunction scores. Crit Care Med. 2006;34(2):314-20.

 

Hutchens MP, Thorborg P. Management of DIC in the ICU: An update. Crit Care Shock. 2004;7:5-12. Texto libre en http://criticalcareshock.org/files/ 200405061151151.pdf

 

Arango-Barrientos M. Coagulación intravascular diseminada. IATREIA. 2010;23(4):344-53.

 

Marco-Schulke CM, Sánchez-Casado M, Hortigüela-Martin VA, Quintana-Díaz M, Rodríguez-Villar S, et al. Trombocitopenia grave al ingreso en una unidad de cuidados intensivos en pacientes con disfunción multiorgánica. Med Intensiva. 2012;36 (3):185-92.

 

Greinacher, A, Selleng K. Thrombocytopenia in the intensive care unit patient. Hematology Am Soc Hematol Educ Program. 2010;135-43.