Disseminated Intravascular Coagulation Is an Independent Predictor of Adverse Outcomes in Children in the Emergency Department With Suspected Sepsis

J Pediatr. 2020 Jun 14;S0022-3476(20)30723-X. doi: 10.1016/j.jpeds.2020.06.022. Online ahead of print.

Abstract

Objective: To evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of ED encounters for children with suspected sepsis, in view of similar associations in adults.

Study design: Laboratory and clinical data were extracted from a registry of Emergency Department (ED) encounters of children with suspected sepsis between April 01, 2012 and June 26, 2017. International Society of Thrombosis and Hemostasis DIC scores were calculated from laboratory values obtained within 24 hours of ED admission. Univariate logistic regression, multivariable logistic regression, and Cox regression were used to assess the influence of DIC scores on vasopressor use (primary outcome), mortality, ventilator requirement, pediatric intensive care unit admission, and hospital duration (secondary outcomes). The optimal DIC score cutoff for outcome prediction was determined.

Results: Of 1,653 eligible patients, 284 had DIC scores within 24 hours, including 92 who required vasopressors and 23 who died within one year. An initial DIC score≥3 was the most sensitive and specific DIC score for predicting adverse outcomes. Those with a DIC score ≥3 vs. <3 had increased odds of vasopressor use in both univariate (OR 4.48, 95%CI 2.63-7.62, P < .001) and multivariable (OR 3.78, 95%CI 1.82-7.85, p<0.001) analyses. Additionally, those with DIC score ≥3 vs <3 had increased 1-year mortality with a hazard ratio of 3.55 (95%CI 1.46-8.64, p=0.005).

Conclusion: A DIC score ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff ≥5.

Keywords: Mortality; Pediatric; Vasopressors.