Clinical Heterogeneity and Prognostic Impact of Disseminated Intravascular Coagulation in Critically Ill Patients: A Large-Scale Retrospective Study

Disseminated intravascular coagulation (DIC) is a serious condition characterized by systemic coagulation activation leading to thrombotic and hemorrhagic complications. Although the characteristics of DIC vary depending on the underlying cause, studies directly comparing coagulation/fibrinolysis laboratory findings across a wide range of underlying diseases are limited.We investigated the characteristics of coagulation/fibrinolysis laboratory results, the frequency of DIC, and the impact of DIC on patient prognosis across various underlying diseases in a critical care setting.This was a single-center retrospective observational study of 1,665 critically ill patients admitted between January 1, 2010, and December 21, 2022. Patients were categorized based on underlying diseases, which included out-of-hospital cardiac arrest, sepsis, trauma, burn, and heat stroke. We retrospectively collected data on background, DIC scores, laboratory results, and in-hospital mortality rates of patients.Significant heterogeneity in coagulation/fibrinolysis laboratory findings was observed, with all findings differing based on the underlying disease (<i>p</i> < 0.001). For example, patients with trauma-associated DIC showed significantly elevated D-dimer and fibrin/fibrinogen degradation product levels, while those with burn-associated DIC tended to have high platelet counts and a rapid decrease in antithrombin activity following admission. Among all underlying diseases, the development of DIC was associated with an increase in in-hospital mortality. This association was particularly strong in patients with trauma or burns.The coagulation/fibrinolysis laboratory findings, along with the clinical trajectory of DIC, exhibit remarkable heterogeneity depending on the precipitating cause. Development of DIC in patients with burn or trauma is strongly associated with increased in-hospital mortality.