Diagnosis and prognosis of overt disseminated intravascular coagulation in a general hospital—Meaning of the ISTH score system, fibrin monomers, and lipoprotein–C-reactive protein complex formation

Abstract

The meaning, the utility, and the prognostic significance of the International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation (DIC) score and other parameters of coagulation activation including soluble fibrin monomer complexes (SFMC), antithrombin and protein C consumption, and formation of lipoprotein-C-reactive protein (LP-CRP) complexes (MDA slope 1 and flag A2) were evaluated in 165 inpatients from a general hospital for whom DIC testing was required by the attending physicians. Of these 165 patients, 148 had an underlying disease that clearly justified the laboratory request from our systematic post hoc review of the clinical charts. Of these 148 patients, 28 had a positive overt DIC score, 19 had an A2 flag, and 4 had both. The DIC score was strongly related to several major markers of coagulation activation such as D-dimers, thrombin-antithrombin complexes, and soluble fibrin and was inversely related to antithrombin and protein C levels, which began to fall from DIC score 4 or higher. The formation of LP-CRP complexes was only related to Gram-negative sepsis and these patients had a strong inflammatory reaction. Independent risk factors for death were high creatininemia, positive overt DIC score, and/or presence of SFMC. In patients with positive DIC score, SFMC positivity and low levels of antithrombin and/or protein C were additional risk factors. The ISTH overt DIC score proves useful and adequate as a marker for clinically significant DIC. Illness severity is further defined by SFMC, antithrombin, and protein C levels. LP-CRP complexes are related to sepsis but not to actual overt DIC and lethal prognosis.

Treatment Effects of Xuebijing Injection in Severe Septic Patients with Disseminated Intravascular Coagulation

“…It is notable that 28-day mortality was significantly lower in the intervention group (Table 2). Previous studies have demonstrated that mortality in septic patients with DIC is significantly higher than in those without DIC, and resolution of DIC is associated with a favorable outcome [30, 31]. In the present study, incidence of DIC was significantly lower after administration of XBJ injection, confirming that this drug is effective in improving short-term prognosis of severe septic patients with DIC.…”

Is Coagulopathy an Appropriate Therapeutic Target During Critical Illness Such as Trauma or Sepsis?

“…JAAM DIC criteria demonstrate high sensitivity and specificity for the diagnosis of DIC(52), and all patients diagnosed with the JAAM criteria were further examined by the criteria of the International Society of Hemostasis and Thrombosis (ISTH) as overt DICs(53). The registry of the JSEPTIC DIC(54) study enrolled 3195 cases with severe sepsis/septic shock over a two-year interval between 2011-2013, with a critically ill population as demonstrated by high mean APACHE II scores (23.1 ± 8.7) and an overall in-hospital mortality rate of 34%.…”

The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma

“…Disseminated intravascular coagulation (DIC) score was calculated according to the scoring system of the International Society on Thrombosis and Haemostasis (ISTH) (Table 1) [14, 15]. Calculation of the score has been validated using either D-dimer or fibrin degradation products (FDP) titer, assigning points based on the degree of increase: none, moderate, or severe coagulation disturbances [15, 16].…”

“…Calculation of the score has been validated using either D-dimer or fibrin degradation products (FDP) titer, assigning points based on the degree of increase: none, moderate, or severe coagulation disturbances [15, 16]. Since FDP titer is not available in our laboratory, we had to modify the score by using D-dimer.…”