International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients

Abstract

We evaluated the score for disseminated intravascular coagulation (DIC) recently published by the International Society for Thrombosis and Haemostasis (ISTH) in a well-defined series of sepsis patients. Thirty-two patients suffering from severe sepsis and eight patients with septic shock were evaluated following the ISTH DIC score. Fibrin monomer and D-dimer were chosen as fibrin-related markers (FRM), respectively. DIC scores for nonsurvivors (n = 13) as well as for septic shock patients were higher (P < 0.04) compared with survivors and patients with severe sepsis, respectively. Using fibrin monomer and D-dimer, 30 and 25% of patients suffered from overt DIC. Overt DIC was associated with significantly elevated thrombin-antithrombin complexes and plasminogen activator inhibitor type-1 levels as well as with significantly lower factor VII clotting activity. Patients with overt DIC had a significantly higher risk of death and of developing septic shock. Since more than 95% of the sepsis patients had elevated FRM, the DIC score was strongly dependent on prolongation of the prothrombin time and platelet counts. The ISTH DIC score is useful to identify patients with coagulation activation, predicting fatality and disease severity. It mainly depends on the prolongation of the prothrombin time and platelet counts.

TREM-like transcript-1 protects against inflammation-associated hemorrhage by facilitating platelet aggregation in mice and humans

“…Upon admission into the ICU, age, sexual phenotype, severity of underlying medical condition stratified according to the criteria of McCabe and Jackson (34), SAPSII (35), SOFA score (33), vital signs, respiratory variables, routine blood test results, and microbial culture results were recorded. The DIC score was calculated according to ISTH recommendations (12). Outcome was assessed during a 28-day follow-up period.…”

“…Although no correlation was found with platelet counts or prothrombin time, sTLT-1 was strongly correlated with D-dimer levels (Rs = 0.82, P < 0.0001; Figure 2C). Consequently, patients suffering from DIC (DIC score > 5) had a higher plasma sTLT-1 concentration than those without DIC ( Figure 2D) (12). Thus, we next sought to evaluate the usefulness of sTLT-1…”

D-dimer antigen: current concepts and future prospects

“…79 The ISTH scoring system for overt DIC has been shown to be a valid predictor of outcome and fatality associated with DIC. 80 The laboratory parameters for assessment of the overt DIC score are the platelet count, prothrombin time, and a fibrin-related marker (FRM), as well as fibrinogen concentration. D-dimers or fibrin degradation products are the most common fibrin-related markers used by clinical laboratories in this context.…”

46-Year-Old Man With Fevers, Chills, and Pancytopenia

“…A score of 5 or higher indicates overt DIC. 5 Our patient's ferritin and triglyceride levels were within the reference range, and parvovirus IgG and IgM antibody test results were also negative. Blood cultures had no growth.…”

“…The mortality for DIC ranges from 43% to 48% as compared with those without. 5 The International Society on Thrombosis and Haemostasis DIC score can be calculated based on platelet count (Ͼ100 ϭ 0, Ͻ100 ϭ 1, Ͻ50 ϭ 2), fibrinogen level (Ͼ100 mg/dL ϭ 0, Ͻ100 mg/dL ϭ 1), prothrombin time (Ͻ15 seconds ϭ 0, Ͼ15 seconds ϭ 1, Ͼ18 seconds ϭ 2), and D-dimer (Ͻ301 ng/mL ϭ 0, Ͼ301 ng/mL ϭ 1, Ͼ400 ng/mL ϭ 2). A score of 5 or higher indicates overt DIC.…”