Trends in the Incidence and Outcomes of Disseminated Intravascular Coagulation in Critically Ill Patients (2004-2010) – A Population Based Study

ABSTRACT BACKGROUND: The incidence and outcomes of disseminated intravascular coagulation (DIC) are incompletely defined. Therefore, we aimed to evaluate the trends in incidence and outcomes of critically ill patients with DIC.

METHODS: We conducted a population-based retrospective cohort study evaluating consecutively admitted adult (≥18 years) critically ill patients with DIC, at Mayo Clinic, MN, from 2004 to 2010. DIC was diagnosed according to the International Society on Thrombosis and Hemostasis overt DIC algorithm. Patients diagnosed with heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, Child Pugh class-C or any known congenital or acquired coagulation disorders were excluded.

RESULTS: Of the 8089 Olmsted county resident ICU admissions, a total of 154 patients met the DIC inclusion criteria. The overall incidence rate of DIC/100000 person-years decreased from 26.2 (95% CI, 17.1-38.4) in 2004 to 18.6 (95% CI, 11.3-28.7) in 2010. The incidence rate of DIC increased with age in both men and women and was consistently higher in men with the exception of age group 18-39 years. The incidence rate/100000 person-years of DIC in men decreased from 41.6 (95% CI, 25.4-64.2) in 2004 to 21.2 (95% CI, 10.6 37.9) in 2010 (p= 0.01), whereas in women, it did not change significantly (p=0.79). The case fatality rate did not change significantly during the study period.

CONCLUSIONS: The incidence of DIC is decreasing over the last decade, significantly in men, although the mortality rate remains the same. This is in agreement with trends in other critical care syndromes and could be attributable to improvements in health care delivery.