Disseminated intravascular coagulation resolution as a surrogate outcome for mortality in sepsis-associated disseminated intravascular coagulation

Sepsis-associated disseminated intravascular coagulation (DIC) contributes to multiple organ dysfunction and increases mortality. Although DIC resolution is considered a therapeutic goal, its validity as a surrogate outcome remains unclear. Identifying key prognostic markers within the DIC score may improve treatment strategies. This study aimed to evaluate the association between DIC resolution and 28-d mortality in patients with sepsis-associated DIC treated with antithrombin and to assess the prognostic value of DIC score components. This study analyzed 2291 patients with sepsis-associated DIC using data from a nationwide post-marketing surveillance of antithrombin concentrates in Japan. Survival analysis and multivariate models were used to assess the associations among DIC resolution, DIC score components, and 28-d mortality. Patients with resolved DIC by day 6 had a significantly lower 28-d mortality rate than those with persistent DIC. Early resolution by day 3 correlated with better survival. Platelet count and prothrombin time-international normalized ratio (PT-INR) were the strongest predictors of mortality, whereas fibrin/fibrinogen degradation product had limited prognostic value. Even among patients with persistent DIC, improvements in the PT-INR and platelet count were associated with better survival. High-dose antithrombin increased DIC resolution rates and showed a trend toward reduced mortality, although the reduction was not statistically significant. DIC resolution is associated with improved survival and may serve as a surrogate outcome. Monitoring key coagulation markers, even in unresolved cases, may help refine the treatment strategies for sepsis-associated DIC. These findings may support future clinical trials targeting coagulopathy in patients with sepsis.