Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation
BackgroundLimited data are available on the relationship of disseminated intravascular coagulation (DIC) with mortality in patients receiving extracorporeal membrane oxygenation (ECMO). Thus, we investigated the association of DIC score and antithrombin (AT) III with clinical outcomes in patients un...
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1335826/full |
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| author | Tae Wan Kim Ryoung-Eun Ko Ki Hong Choi Chi Ryang Chung Yang Hyun Cho Jeong Hoon Yang Jeong Hoon Yang |
| author_facet | Tae Wan Kim Ryoung-Eun Ko Ki Hong Choi Chi Ryang Chung Yang Hyun Cho Jeong Hoon Yang Jeong Hoon Yang |
| author_sort | Tae Wan Kim |
| collection | DOAJ |
| description | BackgroundLimited data are available on the relationship of disseminated intravascular coagulation (DIC) with mortality in patients receiving extracorporeal membrane oxygenation (ECMO). Thus, we investigated the association of DIC score and antithrombin (AT) III with clinical outcomes in patients undergoing ECMO.MethodsWe analyzed 703 patients who underwent ECMO between January 2014 and May 2022 at Samsung Medical Center. The DIC score was calculated using laboratory findings within 24 h of the ECMO initiation, and ≥ 5 was defined as overt DIC. In addition, the AT III level was measured to identify the correlation with the DIC score.ResultsAmong the study patients, 169 (24.0%) were diagnosed with overt DIC (DIC group) during early maintenance therapy. In-hospital mortality was significantly higher in the DIC group than in the non-DIC group (55.0% vs. 36.5%, p < 0.001). Bleeding events were significantly higher in the group of patients with a DIC score of 7 or 8 than in the other group (20.8% vs. 8.4%, p = 0.038). DIC score negatively correlated with AT III level (r = −0.417, p < 0.001). The predictive performance of AT III for overt DIC had statistical significance with a c-static of 0.81 (95% confidence interval (CI), 0.77–0.84, p < 0.001).ConclusionOvert DIC was associated with higher in-hospital mortality and a tendency to bleed in ECMO patients. Furthermore, AT III plasma levels can easily predict overt DIC in patients undergoing ECMO. These findings suggest that monitoring AT III plasma levels may be important in the management of ECMO. |
| first_indexed | 2024-04-24T07:04:05Z |
| format | Article |
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| issn | 2296-858X |
| language | English |
| last_indexed | 2024-04-24T07:04:05Z |
| publishDate | 2024-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-3df35ef88ff94b36b0a1fe522e220eca2024-04-22T04:53:00ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-04-011110.3389/fmed.2024.13358261335826Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenationTae Wan Kim0Ryoung-Eun Ko1Ki Hong Choi2Chi Ryang Chung3Yang Hyun Cho4Jeong Hoon Yang5Jeong Hoon Yang6Department of Pulmonary and Critical Care Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of KoreaDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDivision of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDepartment of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDepartment of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaDivision of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of KoreaBackgroundLimited data are available on the relationship of disseminated intravascular coagulation (DIC) with mortality in patients receiving extracorporeal membrane oxygenation (ECMO). Thus, we investigated the association of DIC score and antithrombin (AT) III with clinical outcomes in patients undergoing ECMO.MethodsWe analyzed 703 patients who underwent ECMO between January 2014 and May 2022 at Samsung Medical Center. The DIC score was calculated using laboratory findings within 24 h of the ECMO initiation, and ≥ 5 was defined as overt DIC. In addition, the AT III level was measured to identify the correlation with the DIC score.ResultsAmong the study patients, 169 (24.0%) were diagnosed with overt DIC (DIC group) during early maintenance therapy. In-hospital mortality was significantly higher in the DIC group than in the non-DIC group (55.0% vs. 36.5%, p < 0.001). Bleeding events were significantly higher in the group of patients with a DIC score of 7 or 8 than in the other group (20.8% vs. 8.4%, p = 0.038). DIC score negatively correlated with AT III level (r = −0.417, p < 0.001). The predictive performance of AT III for overt DIC had statistical significance with a c-static of 0.81 (95% confidence interval (CI), 0.77–0.84, p < 0.001).ConclusionOvert DIC was associated with higher in-hospital mortality and a tendency to bleed in ECMO patients. Furthermore, AT III plasma levels can easily predict overt DIC in patients undergoing ECMO. These findings suggest that monitoring AT III plasma levels may be important in the management of ECMO.https://www.frontiersin.org/articles/10.3389/fmed.2024.1335826/fulldisseminated intravascular coagulationextracorporeal membrane oxygenationantithrombin IIIbleedingthrombosis |
| spellingShingle | Tae Wan Kim Ryoung-Eun Ko Ki Hong Choi Chi Ryang Chung Yang Hyun Cho Jeong Hoon Yang Jeong Hoon Yang Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation Frontiers in Medicine disseminated intravascular coagulation extracorporeal membrane oxygenation antithrombin III bleeding thrombosis |
| title | Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation |
| title_full | Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation |
| title_fullStr | Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation |
| title_full_unstemmed | Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation |
| title_short | Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation |
| title_sort | overt disseminated intravascular coagulation and antithrombin iii predict bleeding and in hospital mortality in patients undergoing extracorporeal membrane oxygenation |
| topic | disseminated intravascular coagulation extracorporeal membrane oxygenation antithrombin III bleeding thrombosis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1335826/full |
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