Timing of disseminated intravascular coagulation onset is associated with development of persistent inflammation, immunosuppression, and catabolism syndrome in critically ill patients.

Abstract

Background: Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is a post-critical illness characterized by sustained inflammation, immune suppression, and hypercatabolism, the mechanisms of which remain unclear. Coagulopathy, which frequently accompanies critical illness, has been suggested to be associated with PIICS; however, few studies have directly investigated this relationship. We hypothesized that the timing of onset of disseminated intravascular coagulation (DIC), a representative form of coagulopathy, is associated with the development of PIICS and aimed to clarify their relationship.

Methods: This study included 100 patients admitted to the intensive care unit (ICU) for ≥ 15 days. PIICS was defined as meeting at least two of the following: elevated C-reactive protein (CRP) level, decreased serum albumin (Alb) level, and decreased lymphocyte count. The primary outcome was the association between the timing of DIC and PIICS development. For each ICU day (days 1-15), risk ratios (RRs) for PIICS were calculated using 2 × 2 contingency tables comparing DIC-positive and DIC-negative patients, and statistical significance was assessed using Fisher's exact test. Multivariable logistic regression analysis was performed to estimate adjusted associations with PIICS development. Statistical analyses were performed via R software. Variables for logistic regression were selected based on previous literature and clinical relevance, with significance level set at p < 0.05.

Results: From approximately day 8 onward, the RR of PIICS in patients with DIC showed an increasing trend. In multivariable analysis, age, cumulative CRP level, and cumulative SOFA score were independently associated with PIICS development. The logistic regression model demonstrated good discrimination (AUC of 0.80).

Conclusions: DIC occurring after approximately day 8 of ICU admission may be associated with an increased risk of PIICS development. These findings suggest that persistent coagulopathy during the middle phase of ICU stay may contribute to the pathogenesis of PIICS.