The prognosis of disseminated intravascular coagulation associated with hematologic malignancy and its response to recombinant human thrombomodulin. Issue 173 (January 2019)

• Record Type: Journal Article
• Authors: Kurita, Naoki; Sakamoto, Tatsuhiro; Kato, Takayasu; Kusakabe, Manabu; Yokoyama, Yasuhisa; Nishikii, Hidekazu; Sakata-Yanagimoto, Mamiko; Obara, Naoshi; Hasegawa, Yuichi; Chiba, Shigeru
• Is Part Of: Thrombosis research. Issue 173(2019)
• Page Start: 57
• Page End: 64
• Publication Date: 2019-01
• Subjects: Disseminated intravascular coagulation -- Hematologic neoplasms -- Thrombomodulin -- Infection -- Mortality; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2018.11.014
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Disseminated intravascular coagulation (DIC) is a lethal complication in patients with hematologic malignancies (HMs). DIC can be induced by the HM itself, but also by HM-associated secondary infection; however, whether difference of triggering factor impacts the outcome of DIC in HM patients remains unknown. The objective of this study is to clarify the difference between HM-induced DIC and infection-induced DIC in HM patients regarding treatment response and prognosis. Methods: HM-induced DIC (158 episodes) and infection-induced DIC in HM patients (83 episodes) from a single center were retrospectively analyzed. Recombinant human thrombomodulin (rhTM) was administered in 149 episodes, while the remaining received conventional therapies. Results: In HM-induced DIC, improvement by day 7 was 46% (95% confidence interval [CI], 38–54), and rhTM enhanced the improvement (hazard ratio [HR], 1.7; 95% CI, 1.1–2.4). In contrast, improvement of infection-induced DIC was significantly worse (29%; 95% CI, 20–39 on day 7), and this was not influenced by rhTM (HR, 1.0; 95% CI, 0.50–2.2). Thirty-day survival in HM-induced DIC and infection-induced DIC was 87% (95% CI, 81–92) and 53% (95% CI, 42–63), respectively, and was not affected by treatment. A DIC score (Japanese Ministry of Health and Welfare criteria) of ≥5 was a predictor of worse survival in both types of DIC (HR, 2.5; 95% CI, 1.5–3.9). Conclusions: This study showed the inadequacy of current therapeutic strategies for secondary infection-induced DIC, the prognosis of which was significantly worse than HM-induced DIC, and the limited efficacy of rhTM only in the improvement of HM-induced DIC. Highlights: Triggering factors of DIC in hematological malignancy (HM) had impact on the outcome. Survival rate of infection-induced DIC in HM was almost half that of HM-induced DIC. Recombinant human thrombomodulin (rhTM) enhanced recovery only from HM-induced DIC. Difference of the survival according to the treatment modalities was not observed.