PB0263 - ISTH DIC and SIC Score are associated with early mortality in children with sepsis induced disseminated intravascular coagulation

Background: Disseminated intravascular coagulation (DIC) is a strong predictor of mortality in patients with sepsis independent of the severity of sepsis. The international society on thrombosis and haemostasis (ISTH) developed ISTH DIC scoring system for diagnosis and prognosis of DIC. Sepsis-induced coagulopathy (SIC) score developed for diagnosis and prognosis of coagulation disturbances in sepsis. However, few of ISTH DIC and SIC scoring data was studied in pediatric setting.

Aims: To compare the early mortality rate of children who diagnosed with sepsis and DIC by using ISTH DIC and SIC score.

Methods: A retrospective study was performed in children age from 28 days to 15 years diagnosed with sepsis and DIC from 2010 to 2019 at Siriraj hospital in Thailand.

Results: Ninety three patients (41 boys, 52 girls) were enrolled. The causative pathogen of sepsis was identified in 68.8%.The most common pathogen was gram-negative bacteria (37.6%). Twenty eight (28.1%) and 65 (69.9%) patients were overt DIC and non-overt DIC, respectively. The early mortality rate of overt DIC patients (78.6%) was statistically significant higher than non-overt DIC patients (43.1%) (p < 0.003). The higher DIC score was correlated with higher mortality rate (r = 0.881) (figure 1). Eighty-three patients were SIC and 10 cases non-SIC (89.2% and 10.8%). The early mortality rate of SIC patients (57.8%) had significantly higher mortality rate than non-SIC patients (20%) (p = 0.04). The higher SIC score was correlated with higher mortality rate (r =0.968) (figure 2). By multivariate analysis, factors affecting mortality rate were septicemia (p= 0.012) and hemoglobin (p = 0.048)

Conclusion(s): Children with overt DIC and SIC had higher early mortality rate than children with non-overt DIC and non-SIC. The higher ISTH DIC and SIC score was associated with higher mortality. The ISTH DIC and SIC score can be used to predict prognosis of sepsis induced DIC in children.