{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:12:26Z","timestamp":1788502346947,"version":"build-2803163510"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200976) and non-DIC groups (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009530) based on DIC criteria. Multivariate logistic regression analysis was performed to evaluate DIC as a prognostic indicator of poor outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The DIC group was older and exhibited higher rates of impaired consciousness, hepatic and renal dysfunction, bleeding\/thrombotic complications, and mortality. Kaplan\u2013Meier analysis showed significantly lower 28-day survival in the DIC group (log-rank\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001). In the multivariate model, DIC remained associated with in-hospital mortality (odds ratio 1.566, 95% CI 1.147\u20132.140,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004). Sub-analyses showed three factors strongly related to poor prognosis: initial DIC score \u22654, FDP sub-score of 3 at presentation, and D1+\/D2\u2009+\u2009or D1-\/D2\u2009+\u2009pattern on day 2.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>JAAM-2 DIC is associated with poor clinical outcomes in patients with heatstroke, supporting the clinical importance of recognizing coagulopathy in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1941386","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:28:42Z","timestamp":1788499722000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Disseminated intravascular coagulation as a prognostic factor in heatstroke: a retrospective cohort study based on Japanese insurance claims"],"prefix":"10.3389","volume":"13","author":[{"given":"Hiroyuki","family":"Koami","sequence":"first","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Saga University","place":["Saga, Japan"]},{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaro","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Saga University","place":["Saga, Japan"]},{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Ushijima","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Saga University","place":["Saga, Japan"]},{"name":"LOCOMOCO (Landmark of 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Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Totoki","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University","place":["Takatsuki, Osaka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Kandori","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department of Emergency and Critical Care Medicine, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Oishi","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department of Emergency and Critical Care Medicine, Kansai Medical University","place":["Osaka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kasumi","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Akita University Graduate School of Medicine","place":["Akita, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yutaka","family":"Umemura","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine","place":["Suita, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuma","family":"Yamakawa","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University","place":["Takatsuki, Osaka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mineji","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department Emergency and General Medicine, Sapporo City General Hospital","place":["Sapporo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohji","family":"Okamoto","sequence":"additional","affiliation":[{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]},{"name":"Department of Surgery, Kitakyushu City Yahata Hospital","place":["Kitakyushu, Fukuoka, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuichiro","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care Medicine, Saga University","place":["Saga, Japan"]},{"name":"LOCOMOCO (Landmark of Clinical Observations in MicrOcirculation and Coagulation Outcomes) Study Group","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.1056\/NEJMra1810762","article-title":"Heatstroke","volume":"380","author":"Epstein","year":"2019","journal-title":"N Engl J 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