Disseminated intravascular coagulation as a prognostic factor in heatstroke: a retrospective cohort study based on Japanese insurance claims.

PURPOSE: Heatstroke is an emerging global health concern, particularly among the elderly. Disseminated intravascular coagulation (DIC) complicates about 20% of these cases and contributes to poor outcomes. The JAAM-2 DIC score, which excludes SIRS, has been validated in sepsis. However, its utility in heatstroke, a condition sharing pathophysiological features with sepsis, remains unexamined. To evaluate the association between heatstroke-associated DIC, defined by JAAM-2 criteria, and clinical outcomes, using a nationwide Japanese database of medical claims.

METHODS

We conducted a retrospective analysis using data from Japanese health insurance claims from 2014 to 2023. Among 2,633 adult patients admitted with heatstroke, 606 cases with complete DIC data on admission were included. Patients were categorized into DIC (n = 76) and non-DIC groups (n = 530) based on DIC criteria. Multivariate logistic regression analysis was performed to evaluate DIC as a prognostic indicator of poor outcomes.

RESULTS

The DIC group was older and exhibited higher rates of impaired consciousness, hepatic and renal dysfunction, bleeding/thrombotic complications, and mortality. Kaplan-Meier analysis showed significantly lower 28-day survival in the DIC group (log-rank P < 0.0001). In the multivariate model, DIC remained associated with in-hospital mortality (odds ratio 1.566, 95% CI 1.147-2.140, P = 0.004). Sub-analyses showed three factors strongly related to poor prognosis: initial DIC score ≥4, FDP sub-score of 3 at presentation, and D1+/D2 + or D1-/D2 + pattern on day 2.

CONCLUSION

JAAM-2 DIC is associated with poor clinical outcomes in patients with heatstroke, supporting the clinical importance of recognizing coagulopathy in this population.