A Prospective Comparative Study of Three Sets of Criteria for Disseminated Intravascular Coagulation: ISTH Criteria vs Japanese Criteria

Abstract

Clinical and laboratory criteria and a scoring system for disseminated intravascular coagulation (DIC) were recently published by the International Society on Thrombosis and Haemostasis (ISTH). In Japan, the DIC Diagnostic Standards published in 1988 have been widely used for more than 10 years. In a general intensive care unit, we prospectively compared the diagnostic properties of the overt DIC, nonovert DIC, and Japanese DIC criteria sets, and investigated the influences of each set on patient morbidity and mortality. Seventy-four patients with platelet counts below 150 × 109/L were included in this study. Blood samples were collected daily from day 0 to day 4 after inclusion in the study. The Japanese DIC included the overt DIC and both of these were included in the nonovert DIC. The Japanese DIC criteria diagnosed DIC earlier than the nonovert DIC criteria did ( P = .020). The DIC patients diagnosed by the Japanese criteria and those diagnosed by the overt DIC criteria showed a higher incidence of multiple organ failure than those without DIC ( P = .013 and P = .022, respectively). The Japanese and the nonovert DIC criteria tended to predict patient prognoses effectively. In conclusion, the Japanese and the nonovert DIC criteria are of value in predicting outcome. However, the nonovert DIC criteria take more time to diagnose DIC than the Japanese criteria do. A more precise clinical study is needed to determined appropriate specific criteria and cutoff points in the nonovert DIC criteria set.

A Prospective Comparison of New Japanese Criteria for Disseminated Intravascular Coagulation

“…On the other hand, we found that the non-overt DIC criteria were unable to diagnose DIC earlier than the old Japanese criteria (2). The non-overt DIC criteria are not sufficient for the early diagnosis and treatment of DIC (2).…”

“…Previously we reported a prospective comparison between the ISTH criteria and the old Japanese criteria (2). We showed that both the non-overt DIC and old Japanese criteria accurately predicted outcomes (2). On the other hand, we found that the non-overt DIC criteria were unable to diagnose DIC earlier than the old Japanese criteria (2).…”

“…In Japan, the DIC Diagnostic Standards (the old Japanese criteria) were published in 1988 and have been widely used for more than 10 years. Previously we reported a prospective comparison between the ISTH criteria and the old Japanese criteria (2). We showed that both the non-overt DIC and old Japanese criteria accurately predicted outcomes (2).…”

“…The patient population overlapped completely with that of our previous study (2). Only patients whose platelet counts were below 150 x 10 9 /L were included in this study.…”

“…However, the prognoses of critically ill patients with DIC have remained poor. To overcome this situation, the Japanese Association for Acute Medicine (JAAM) and the Japanese Society on Thrombosis and Hemostasis (JSTH) cooperated in 2002 to establish new DIC criteria for critically ill patients (the new Japanese criteria) (2). This new criteria set adopts the concept of coagulopathy associated systemic inflammatory response syndrome (SIRS-associated coagulopathy) and incorporates SIRS scores.…”