D-dimer levels and the disseminated intravascular coagulation score to predict severity and outcomes in sepsis or septic shock

• Verfasst von: Schupp, Tobias [VerfasserIn]
• Verfasst von: Weidner, Kathrin [VerfasserIn]
• Verfasst von: Rusnak, Jonas [VerfasserIn]
• Verfasst von: Jawhar, Schanas [VerfasserIn]
• Verfasst von: Forner, Jan [VerfasserIn]
• Verfasst von: Dulatahu, Floriana [VerfasserIn]
• Verfasst von: Brück, Lea Marie [VerfasserIn]
• Verfasst von: Hoffmann, Ursula [VerfasserIn]
• Verfasst von: Kittel, Maximilian [VerfasserIn]
• Verfasst von: Bertsch, Thomas [VerfasserIn]
• Verfasst von: Akın, Ibrahim [VerfasserIn]
• Verfasst von: Behnes, Michael [VerfasserIn]
• Titel: D-dimer levels and the disseminated intravascular coagulation score to predict severity and outcomes in sepsis or septic shock
• Verf.angabe: Tobias Schupp, Kathrin Weidner, Jonas Rusnak, Schanas Jawhar, Jan Forner, Floriana Dulatahu, Lea M. Bruck, Ursula Hoffmann, Maximilian Kittel, Thomas Bertsch, Ibrahim Akin, Michael Behnes
• Jahr: 2023
• Umfang: 12 S.
• Fussnoten: Gesehen am 09.08.2023
• Titel Quelle: Enthalten in: Clinical laboratory
• Ort Quelle: Heidelberg : Clin Lab Publ., Verl. Klinisches Labor, 1992
• Jahr Quelle: 2023
• Band/Heft Quelle: 69(2023), 5, Seite 985-996
• DOI: doi:10.7754/Clin.Lab.2022.221015
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: D-dimer levels
• Sach-SW: DIC score
• Sach-SW: mortality
• Sach-SW: prog-nosis
• Sach-SW: sepsis
• Sach-SW: septic shock
• K10plus-PPN: 1854991051

Abstract

Background: Studies investigating the diagnostic and prognostic value of D-dimer levels and the disseminated in-travascular coagulation (DIC) score in sepsis or septic shock commonly include preselected subgroups of patients or were published prior to the current sepsis-3 criteria. Therefore, this study investigates the diagnostic and prog-nostic impact of D-dimer levels and the DIC score in patients with sepsis and septic shock. Methods: Consecutive patients with sepsis and septic shock enrolled in the prospective and monocentric "MARSS" registry from 2019 to 2021 were included. First, the diagnostic value of D-dimer levels was compared to the DIC score to discriminate patients with septic shock from patients with sepsis without shock. Thereafter, the prognostic value of D-dimer levels and the DIC score was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman ' s correlations, C-statistics, Kaplan-Meier, as well as uni-and multivariable cox regression analyses. Results: One hundred patients were included (n = 63 with sepsis and n = 37 with septic shock). The overall rate of all-cause mortality at 30 days was 51%. With an area under the curve (AUC) of 0.710 and 0.739, both D-dimer level and the DIC score revealed reliable diagnostic accuracy for the discrimination of septic shock. However, D-dimer levels and the DIC scores were shown to have poor to moderate prognostic accuracy (AUC 0.590 -0.610) with regard to 30-day all-cause mortality. Specifically, very high D-dimer levels (i.e., > 30 mg/L) (HR = 2.648; 95% CI 1.147 -6.112; p = 0.023) and a DIC scores >= 3 (HR = 2.095; 95% CI 1.095 -4.009; p = 0.0258) were associ-ated with highest risk of 30-day all-cause mortality. Finally, both higher D-dimer levels (HR = 1.032; 95% CI 1.005 -1.060; p = 0.021) and DIC scores (HR = 1.313; 95% CI 1.106 -1.559; p = 0.002) were associated with in-creased risk of 30-day all-cause mortality after multivariable adjustment. Conclusions: Both D-dimer levels and the DIC scores revealed reliable diagnostic accuracy for the discrimination of septic shock, but a poor to moderate prognostic value for the discrimination of 30-day all-cause mortality. Espe-cially very high D-dimer levels (i.e., > 30 mg/L) and a DIC score >= 3 were associated with highest risk of 30-day all-cause mortality.