Disseminated intravascular coagulation and sustained systemic inflammatory response syndrome predict organ dysfunctions after trauma - Application of clinical decision analysis

Objective To determine the accuracy of disseminated intravascular coagulation (DIC) and sustained systemic inflammatory response syndrome (SIRS) in predicting posttrauma multiple organ dysfunction syndrome (MODS) and to find a simple laboratory test for detecting MODS. Summary and Background Data In trauma patients, the duration of SIRS is the main determinant for MODS and outcome. Methods One hundred thirty-six patients with trauma were classified into subgroups according to the duration of SIRS: patients without SIRS (n = 27), patients with SIRS for less than or equal to 2 days (n = 52), and patients with SIRS for greater than or equal to 3 days (n = 57). Platelets and five coagulation and fibrinolytic laboratory tests for diagnosing DIC were measured on the day of admission and on days 1 through 4 after admission. Simultaneously, the DIC score was determined. The diagnostic accuracy of DIC and sustained SIRS for the prediction of MODS was determined using likelihood ratios. A receiver operating characteristic curve of platelet counts for predicting MODS was also constructed. Results Platelet counts showed significant differences among the three groups. The incidence of DIG, acute respiratory distress syndrome, and MODS was significantly higher in patients with SIRS for greater than or equal to 3 days compared with those in the other groups, and they had a poor outcome. Likelihood ratios of DIC and SIRS for greater than or equal to 3 days for predicting posttrauma MODS were 11.6 and 6.25, respectively. Platelet counts (80 x 10(9)/l) on day 1 had a sensitivity of 83.3% and a specificity of 100% for predicting MODS. Conclusions Disseminated intravascular coagulation and sustained SIRS are strong determinants for posttrauma MODS. This retrospective analysis supports the possibility that platelet counts can be used as a simple laboratory test for predicting MODS. This hypothesis requires proof using a prospective clinical survey.