Disseminated intravascular coagulation, associated Factors, and clinical outcomes among critically ill Septic adults admitted to intensive care units jimma University medical center: a prospective longitudinal Study

Abstract

Background: Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes. It is marked by a deficiency of natural coagulation inhibitors, consumption of clotting factors and platelets, tissue injury due to circulatory abnormalities causing multi organ failure, and life-threatening hemorrhage. DIC is common in sepsis and septic shock patients and is associated with poor prognosis. Despite the established link between sepsis and DIC, there is no reported data in Ethiopia on the prevalence of DIC, associated factors and patient outcomes in sepsis patients. Objective: - To determine the prevalence of DIC and associated factors, and mortality predictors in septic adults admitted to intensive care units (ICUs) of Jimma University Medical Center from October 1, 2023, to September 30, 2024. Method: - A prospective longitudinal study was conducted involving 148 critically ill septic patients using consecutive sampling technique. A structured checklist and questionnaire were used to collect patient’s demographic and clinical data. Blood samples were collected on day 1, day 3, and day 5 of ICU admission for all laboratory analyses. A DIC diagnosis was made based on the Japanese Association for Acute Medicine (JAAM) score. Descriptive statistics, multivariable logistic regression analysis, receiver operating curve (ROC) analysis, and Kaplan Meier survival analysis were employed in this study. For all reported results, a p-value <0 .05 was considered statistically significant. Result: -The overall prevalence of DIC in sepsis patients was 38 (25.7%). Patients who developed DIC at day 1 of admission were 24 (16.2%), while 20 (19.4%), and 9 (12.9%) patients developed DIC on day 3, and day 5 of admission, respectively. Increased aspartate transaminase (AST) (AOR: 4.39; 95% CI: 1.75-11.01), thrombocytopenia (AOR: 6.04; 95% CI: 2.41-15.12), and prolonged prothrombin time (PT) (AOR: 3.40; 95 CI: 1.36-8.51) were independent predictors of DIC in sepsis patients. There was no statistically significant difference in survival between patients with and without DIC (p<0.328). Moreover, the JAAM score at ICU admission predicted ICU mortality (AUC: 0.787; 95% CI: 0.624-0.950), and at a cut-off point of > 7, JAAM score yielded the sensitivity and specificity of 100% and 75%, respectively. Conclusion: - A quarter of ICU-admitted septic adults developed DIC. Elevated AST liver enzyme levels, thrombocytopenia, and prolonged PT were linked to the development of DIC. Changes in these variables could prompt further examination for DIC. The mortality rate did not significantly differ between septic patients with and without DIC. The JAAM score used to diagnose DIC in sepsis can serve as a predictor of ICU mortality.