Abstract Number: PB1989
Meeting: ISTH 2020 Congress
Background: DIC contributes to multiple organ dysfunction syndrome (MODS) and mortality in sepsis. Sepsis induces DIC due to dysregulated host response to infection and unremitting systemic inflammation. A suggested cause of unremitting systemic inflammation is unresolved infection due to immune paralysis/lymphoid depletion syndrome. The frequency of this syndrome in sepsis-induced DIC is unknown.
Aims: We hypothesize that patients who died with sepsis-induced DIC have autopsy evidence of disseminated microvascular thrombosis, unresolved infection and lymphoid depletion.
Methods: We reviewed consecutive autopsy reports of children who died with a diagnosis of sepsis from 1/2017 to 4/2018 in a tertiary care university-based pediatric hospital. Septic patients were identified by Electronic Medical Record query using diagnostic codes for “sepsis” and “septic shock.” Clinical DIC was diagnosed based on the International Society of Thrombosis and Haemostasis criteria.
Results: Out of 330 septic children identified, there were 79/330(24%) deaths. Clinical DIC was present in 110/330(33%) septic children, of whom 44/110(40%) died. Autopsies were performed on 16/79(20%) deaths. Clinical DIC was present in 11/16(69%) patients with autopsies. All 11/11(100%) DIC patients died with MODS. Patients with DIC had evidence of microvascular thrombosis in the kidneys 6/11(55%), lungs 6/11(55%), heart 6/11(55%), liver 3/11(27%), and brain 0/11(0%). 8/11(73%) patients with DIC had active infections found on autopsy categorized as: gram negative 4/8(50%) and gram positive 5/8(63%) bacteria, fungus 1/8(13%), and more than one pathogen 3/8(38%). Hypocellular bone marrow and/or lymphocyte depletion in the lymph nodes or thymus was found in 5/11(45%) patients with DIC.
Conclusions: All sepsis-induced DIC patients with autopsies died with MODS. Over half of clinical DIC autopsy reports showed evidence of microvascular thrombosis in the kidneys, lungs and heart. The majority of DIC deaths had unresolved infection suggesting a cause for unremitting systemic inflammation. Less than half of DIC patients had lymphocyte depletion suggesting immune dysregulation. Further studies are warranted.
To cite this abstract in AMA style:Smaglick M, Kennedy C, Lang A, Goldman J, Bashir D, Saini A, Desai M, Marini J, Cruz M, Nguyen T. Prevalence of Disseminated Microvascular Thrombosis, Unresolved Infection, and Lymphoid Depletion in Autopsies of Pediatric Sepsis-Induced Disseminated Intravascular Coagulation (DIC) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/prevalence-of-disseminated-microvascular-thrombosis-unresolved-infection-and-lymphoid-depletion-in-autopsies-of-pediatric-sepsis-induced-disseminated-intravascular-coagulation-dic/. Accessed January 28, 2022.
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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prevalence-of-disseminated-microvascular-thrombosis-unresolved-infection-and-lymphoid-depletion-in-autopsies-of-pediatric-sepsis-induced-disseminated-intravascular-coagulation-dic/