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      Overt disseminated intravascular coagulation and antithrombin III predict bleeding and in-hospital mortality in patients undergoing extracorporeal membrane oxygenation

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          Abstract

          Background

          Limited 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.

          Methods

          We 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.

          Results

          Among 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).

          Conclusion

          Overt 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.

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          Most cited references27

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          Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium.

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            Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation.

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              Disseminated intravascular coagulation.

              M. LEVI, H Ten Cate (1999)
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                Author and article information

                Contributors
                Tae Wan Kim: URI : https://loop.frontiersin.org/people/2101649/overviewRole: Role: Role: Role: Role: Role:
                Ryoung-Eun Ko: URI : https://loop.frontiersin.org/people/1902844/overviewRole: Role: Role: Role: Role:
                Ki Hong Choi: Role: Role: Role:
                Chi Ryang Chung: Role: Role: Role: Role:
                Yang Hyun Cho: Role: Role: Role: Role: Role:
                Jeong Hoon Yang: URI : https://loop.frontiersin.org/people/1816850/overviewRole: Role: Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Med (Lausanne)
                Journal ID (iso-abbrev): Front Med (Lausanne)
                Journal ID (publisher-id): Front. Med.
                Title: Frontiers in Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2296-858X
                Publication date (Electronic): 22 April 2024
                Publication date Collection: 2024
                Volume: 11
                Electronic Location Identifier: 1335826
                Affiliations
                [1] 1Department of Pulmonary and Critical Care Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine , Seoul, Republic of Korea
                [2] 2Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
                [3] 3Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
                [4] 4Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, Republic of Korea
                Author notes

                Edited by: Massimo Cressoni, IRCCS San Donato Polyclinic, Italy

                Reviewed by: Agnese Ozolina, Riga Stradiņš University, Latvia

                Heidi J. Dalton, Inova Health System, United States

                *Correspondence: Jeong Hoon Yang, jhysmc@ 123456gmail.com
                Article
                DOI: 10.3389/fmed.2024.1335826
                PMC ID: 11075479
                PubMed ID: 38716413
                SO-VID: 2ff9fbbf-9f06-465a-901d-bdaec980c97d
                Copyright © Copyright © 2024 Kim, Ko, Choi, Chung, Cho and Yang.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 22 November 2023
                Date accepted : 19 March 2024
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 27, Pages: 9, Words: 4908
                Funding
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Subject: Medicine
                Subject: Original Research
                Custom metadata
                section-at-acceptance Intensive Care Medicine and Anesthesiology

                Keywords: disseminated intravascular coagulation,extracorporeal membrane oxygenation,antithrombin iii,bleeding,thrombosis
                Data availability:
                Keywords: disseminated intravascular coagulation, extracorporeal membrane oxygenation, antithrombin iii, bleeding, thrombosis

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