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  • Clinical Research Article
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Prevalence and risk factors of disseminated intravascular coagulation in childhood acute lymphoblastic leukemia

Pediatric Research volume 94, pages 588–593 (2023)Cite this article

Abstract

Background

Few studies have examined disseminated intravascular coagulation (DIC) in childhood acute lymphoblastic leukemia (ALL). Our aims were to evaluate the prevalence, risk factors and outcomes of DIC at ALL presentation and during induction chemotherapy.

Methods

The medical records of ALL patients aged <15 years were retrospectively reviewed. Logistic regression analysis was used to identify risk factors. The Kaplan–Meier method was used to depict survival.

Results

Of the 312 patients, 48 (15.4%) and 76 (24.4%) had DIC at presentation and during induction chemotherapy, respectively. Risk factors for DIC at presentation (OR and 95% CI) were antibiotics prior to admission 2.34 (1.17–4.89), white blood cell count ≥100 × 109/L 2.39 (1.04–5.72), platelets <100 × 109/L 5.44 (1.84–23.4) and high National Cancer Institute (NCI) risk 2.68 (1.08–6.62). Risk factors for DIC during induction chemotherapy were antibiotics prior to admission 1.86 (1.07–3.27), high peripheral blasts 1.01 (1.00–1.02) and transaminitis 2.02 (1.18–3.48). Five-year overall survival of patients who had DIC was significantly lower than those who did not (45.0% vs. 74.1%, p <0.001).

Conclusion

Antibiotics prior to admission, hyperleukocytosis, thrombocytopenia and high NCI risk were risk factors of DIC at presentation. Antibiotics prior to admission, high peripheral blasts and transaminitis were risk factors of DIC during induction chemotherapy.

Impact

  • There are only two studies, both published before 2000, evaluating risk factors of DIC in pediatric ALL patients without reporting outcomes.

  • DIC was associated with lower remission and survival rates in pediatric ALL patients. We identified the risk factors of DIC at presentation as antibiotics prior to admission, hyperleukocytosis, thrombocytopenia and high NCI risk. The risk factors of DIC during induction chemotherapy were antibiotics prior to admission, high peripheral blasts and aspartate transaminitis.

  • Pediatric ALL patients who have the aforementioned risk factors should be closely monitored for DIC secondary to infection, and early treatment with appropriate antimicrobial agents is recommended.

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Fig. 1: Kaplan–Meier survival curves stratified by the presence of disseminated intravascular coagulation (DIC) between presentation and end of induction chemotherapy.

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Data availability

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We would like to thank Dave Patterson of the Office of International Affairs, Faculty of Medicine, Prince of Songkla University for his English editing.

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Pediatrics, Prince of Songkla University, Hat Yai, Songkhla, Thailand

    Natsaruth Songthawee, Shevachut Chavananon, Pornpun Sripornsawan & Thirachit Chotsampancharoen

  2. Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand

    Edward McNeil

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  1. Natsaruth Songthawee
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Contributions

N.S., S.C., P.S., E.M. and T.C. made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data. N.S. and T.C. were primarily responsible for drafting and revising the manuscript for important intellectual content. All authors provided final approval of the manuscript to be submitted for publication.

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Correspondence to Thirachit Chotsampancharoen.

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Songthawee, N., Chavananon, S., Sripornsawan, P. et al. Prevalence and risk factors of disseminated intravascular coagulation in childhood acute lymphoblastic leukemia. Pediatr Res 94, 588–593 (2023). https://doi.org/10.1038/s41390-023-02475-8

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