Discussion
Patients with DIC in Ramathibodi Hospital had high mortality rate and short median survival. Siegal et at.6 showed that DIC patients had mortality rate of 58% as compared with 70% in our study. Mortality rate was higher in patients admitted in the ICU (81%). Toh and Downey7 showed that the mortality rates of patients with overt DIC and non-overt DIC were 73% and 26%, respectively. Our study showed that mortality rates of patients with overt DIC and non-overt DIC were 75% and 57%, respectively. Patients with non-overt DIC had higher mortality in our study. This might be because of the progression from non-overt DIC to overt DIC later. In our study, DIC was diagnosed when there was a confirmed underlying disease plus fulfilled laboratory criteria. We did not change the score when the disease progressed.
Sepsis was the most common etiology of DIC patients in this study, followed by malignancy. Wada et al.8 showed that sepsis was a common cause but the most frequent etiology associated with DIC was acute promyelocytic leukemia (APL) in their study. In our study, only two patients with APL developed DIC. Treatment with all-trans retinoic acid during the induction period in our APL patients at Ramathibodi Hospital might have contributed to the low incidence of DIC in these patients.
Co-morbidity factors that were found in DIC were shock, respiratory failure, and acute renal failure. These patients were admitted in the ICU and had higher mortality. Heart disease, including myocardial infarction, cardiac arrhythmia, and congestive heart failure were found in about 10% of cases but they did not affect