Heterogeneity in the incidence and clinical manifestations of disseminatedintravascular coagulation: A study of 204 cases

The incidence and clinical manifestations of disseminated intravascular coa gulation (DIC) were examined in patients with a range of underlying disorde rs. Out of 1,882 patients suspected as having DIG, 204 cases were diagnosed as suffering from DIC and included in this study. The underlying disorders experienced by the patients were solid tumors (33.8%), hematologic maligna ncies (12.7%), aortic aneurysm (10.8%), infections (6.4%), post-operative c omplications (4.4%), liver disease (2.9%), obstetric disorders (2.5%), and miscellaneous diseases (26.5%). The incidence of DIC was 10.8% out of all p atients suspected of having DIG, and the etiologies were 10.9% in solid tum ors, 10.1% in hematological malignancies, 20.4% in aortic aneurysm, 12.7% i n infections, 15.5% in post-operative complications, 15.8% in liver disease , 3.7% In obstetric disorders, and 9.8% in miscellaneous diseases. The clin ical manifestations of DIC patients were varying dependent on their etiolog ies. Most DIC patients with aortic aneurysm (95.5%) and postoperative compl ications (88.9%) did not reveal any clinical manifestations. Although all o f the patients with obstetric disorders had bleeding, only 20.0% of the pat ients had organ failure. In contrast, although only 15.4% of the patients w ith Infections had bleeding, 76.9% of these patients had organ failure. Ble eding was observed in 31.9-50.0% of DIC patients with liver disease, hemato logic malignancies, and solid tumors. Organ failure was observed in 21.7-33 .3% of DIC patients with liver disease, hematological malignancies, and sol id tumors. Analysis by measurement of plasma levels of antiplasmin and plas min-antiplasmin complex suggested that excessive fibrinolysis might contrib ute to the development of bleeding in these DIC patients. Differences in pl asma levels of thrombin-antithrombin complex and cross-linked fibrin degrad ation products could not account for the differences in the incidence of or gan failure in the patients. These findings suggest that the clinical manif estation of DIC varies and might not only be a reflection of microthrombus formation but also a reflection of the other underlying pathomechanisms. (C ) 2000 Wiley-Liss, Inc.