Prognostic value of a simple evolving disseminated intravascular coagulation score in patients with severe sepsis

Objective: We postulated that the coagulopathy initiated by the inflammatory response to severe sepsis would be reflected by changes in the platelet count and prothrombin time that convey prognostic information. To examine this hypothesis, we looked at the utility of a simple evolving disseminated intravascular coagulation (DIC) score that awarded 1 point for each of the following: a) an absolute platelet count < 100 x 10(9)/L; b) a prothrombin time > 15.0 secs; c) a 20% decrease in platelets; and d) a > 0.3-sec increase in prothrombin time in predicting outcome in patients with severe sepsis. Design: Prospective observational study. Setting: Intensive care units of university medical center. Patients: Patients were 163 critically ill severe sepsis patients. Interventions: None. Measurements and Main Results: Patients were clinically classified as having capillary leak syndrome (n = 24), multiple organ failure with death from sepsis (n = 37), or multiple organ failure with recovery (n = 57) or as well (n = 45) if they showed rapid improvement in their modified Multiple Organ Dysfunction Syndrome (MODS) score (which did not score for thrombocytopenia). Patients with capillary leak syndrome had the highest Acute Physiology and Chronic Health Evaluation II score, modified MODS, and prothrombin time and the lowest platelet counts, whereas well patients had the most normal values. The simple evolving DIC score increased with worsening clinical class and was associated with worsening organ failure (increased modified MODS). Mortality rate increased from 10% for a simple evolving score of 0 to 73% for a score of 4 (p <.01). Overall, 86% of those with a score < 1 survived, whereas 85% of those with a score of > 2 developed multiple organ failure and half of them died from sepsis. Conclusions: The simple evolving DIC score calculated in the first 48 hrs from two readily available global coagulation markers appears to reflect the severity of the underlying disorder. It can be easily calculated at the bedside and provides useful prognostic information for the patient with severe sepsis.