Background Septic-associated disseminated intravascular coagulation (DIC) is heterogeneous regarding prognosis and responsiveness to anticoagulant therapy.

Objectives To investigate the relationship between the timing of development and recovery of DIC, its prognosis, and the difference in response to anticoagulant therapy in sepsis-associated DIC patients.

Methods This study was performed with a dataset from a multicenter nationwide retrospective cohort study (J-Septic DIC registry) in Japan between 2011 and 2013 to reveal the subgroup “high risk of death in DIC” and investigate the relationship between anticoagulant use and mortality. Patients were assigned to four groups based on the International Society on Thrombosis and Haemostasis-overt DIC status at days 1 and 3: non-DIC (−/−), early-recovered DIC (+/−), late-onset DIC (−/+), and persistent DIC (+/+).

Results A total of 1,922 patients were included. In-hospital mortality in persistent and late-onset DIC patients was significantly higher than in patients with non-DIC and early-recovered DIC. This finding indicates that persistent DIC and late-onset DIC were a poor-prognosis subgroup, “high-risk” DIC. Meanwhile, patients with high-risk DIC treated with anticoagulants had significantly better outcomes than those without anticoagulants after adjusting for confounding factors.

Conclusion This study showed that individuals with a high risk of death, persistent DIC, and late-onset DIC were a poor-prognostic subgroup in septic DIC; however, high-risk DIC is also a subgroup that can obtain more benefits from anticoagulant therapy.

背景 脓毒症相关的弥散性血管内凝血（DIC）在预后和对抗凝治疗的反应方面存在异质性。

目的 探讨脓毒症相关 DIC 患者 DIC 发生和恢复时间、预后以及抗凝治疗反应差异之间的关系。

方法 本研究采用 2011 年至 2013 年日本多中心全国回顾性队列研究（J-Septic DIC 登记处）的数据集，揭示“DIC 死亡高风险”亚组，并调查抗凝药物使用与死亡率之间的关系。根据国际血栓和止血学会第 1 天和第 3 天的 DIC 状态，将患者分为四组：非 DIC (−/−)、早期恢复的 DIC (+/-)、迟发性 DIC (−) /+) 和持续性 DIC (+/+)。

结果 共纳入 1,922 名患者。持续性和迟发性 DIC 患者的院内死亡率显着高于非 DIC 和早期恢复的 DIC 患者。这一发现表明持续性 DIC 和迟发性 DIC 是预后不良的亚组，即“高风险”DIC。同时，在调整混杂因素后，接受抗凝治疗的高危 DIC 患者的预后明显优于未接受抗凝治疗的患者。

结论 本研究表明，死亡风险高、持续性 DIC 和迟发性 DIC 的个体是脓毒症 DIC 的预后不良亚组；然而，高危DIC也是一个可以从抗凝治疗中获得更多益处的亚组。