Hypofibrinogenemia is Associated With a High Degree of Risk in Infectious and Hematological Diseases: A Post-Hoc Analysis of Post-Marketing Surveillance of Patients With Disseminated Intravascular Coagulation Treated With Thrombomodulin Alfa

Abstract Introduction In patients with infectious diseases, disseminated intravascular coagulation (DIC) is often diagnosed without the fibrinogen value and the relationship between hypofibrinogenemia and the outcomes of infectious DIC has remained unclear.Materials and Methods We analyzed 3204 patients who received with thrombomodulin alfa (TM-α) for with DIC and suspected DIC. Hypofibrinogenemia was defined by a fibrinogen level of <1.5 g/L.Results Hypofibrinogenemia was observed in 10.3% of patients with infectious diseases. The frequencies of both bleeding and organ failure symptoms, and the scores for organ failure or the DIC diagnostic criteria were significantly high in infectious disease patients with hypofibrinogenemia, suggesting that in patients with infectious diseases, hypofibrinogenemia is associated with more progressive and severe DIC. Although the 28-day survival rate and the DIC resolution rate were both significantly lower in infectious disease patients with DIC with hypofibrinogenemia than in those without hypofibrinogenemia, this difference was not observed in DIC patients with hematological diseases.Conclusion In infectious disease patients with DIC, hypofibrinogenemia may reflect from the increased consumption of fibrinogen due to an accelerated coagulating reaction, while that in hematological disease patients DIC may be caused by fibrinogenolysis due to hyperfibrinolysis, and frequently results in bleeding and multiple-organ failure.