Impact of Disseminated Intravascular Coagulation (DIC) Score Change on Organ Dysfunctions in Septic Shock Patients

INTRODUCTION: The presence of disseminated intravascular coagulation (DIC) and septic shock, each independently, is associated with a higher risk of organ dysfunction and increased mortality(1). The coexistence of both conditions significantly impacts the outcomes in critically ill patients. However, there is limited literature exploring the relationship between the DIC score and organ dysfunction during the septic shock condition(2). OBJECTIVE: We aimed to study the changes in the DIC score and its correlation with organ dysfunction (changes in SOFA score) over 7 days, in septic shock patients. MATERIAL AND METHODS: After the institute ethics committee approval, this prospective observational study was conducted in a 30-bed ICU of a university hospital. All adult ICU patients with septic shock (as per Sepsis-3 criteria) requiring vasopressor support for at least 12 hours were considered for inclusion. Patients were excluded if septic shock duration was more than 24 hours at the time of the inclusion. After the informed consent, blood sample were collected at inclusion (T1) and at seven days (T2), for analysing platelet count, prothrombin time, D-dimer and fibrinogen levels. For each patient, the DIC score (International Society on Thrombosis and Haemostasis, ISTH) and the SOFA (Sequential Organ Failure Assessment) score were recorded at T1 and T2. The correlation between the changes in DIC score and SOFA score, from T1 to T2 was assessed in these patients, using Pearson correlation coefficient. Decision trees analysis including classification and regression trees was used to identify the factors predicting the mortality. RESULTS: During study period, 26 patients were included with median (IQR) age of 39 years (18-65), 16 (64%) were male, 10 (40%) had comorbidities. The majority, 21 (84%), had medical conditions, and 12 (48%) had respiratory system involvement as the primary organ. At inclusion (T1), 23 (88%) were on mechanical ventilation, 8 (30%) requiring renal replacement therapy, the median (IQR) DIC score was 3 (2-5) and the SOFA score was 10 (4-19), with a Pearson correlation coefficient of ρ=-0.06 (p value of 0.74). On T2, the median (IQR) DIC score was 2 (1-4) and the SOFA score 8 (1-14), with a Pearson correlation coefficient of ρ=-0.26 (p value of 0.25). The change in scores (delta T1-T2) showed a median delta DIC score of 1 (-1 to 2) and a delta SOFA score of 2 (-2 to 9), showed a significant correlation, with ρ=0.53 (p value of 0.01) (Fig. 1). Classification and regression tree (CART) analysis revealed that patients with an average delta DIC change of less than 0.5 had an 86% mortality rate, while those with a delta DIC change greater than 0.5 had a 46% mortality rate (Fig. 2). CONCLUSION: Our study suggest that there is a significant association between DIC score kinetics and the severity of organ dysfunction as reflected by the changes in the SOFA score, over seven days after the onset of septic shock. ACKNOWLEDGEMENT: We acknowledge the support from the Instrumentation Laboratory India Pvt. Ltd. for providing the kits for D-dimer assays.