Modified non‐overt DIC diagnostic criteria predict the early phase of overt‐DIC

Abstract

of Thrombosis Hemostasis/DIC subcommittee Diagnostic criteria for non-overt disseminated intravascular coagulation (DIC) have been proposed by the International Society of Thrombosis and Hemostasis, but are not useful for the diagnosis of early phase of overt-DIC (pre-DIC). Therefore, in the current study the non-overt DIC diagnostic criteria were modified using the global coagulation tests, the change rate in the global coagulation tests and molecular hemostatic markers to detect the pre-DIC state and were prospectively evaluated in 613 patients with underlying DIC disease. The frequencies of patients with DIC (DIC positive), late onset DIC, and without DIC (DIC absent) were 29.5%, 7.2%, and 63.3%, respectively. The modified non-overt-DIC criteria can correctly predict 43/44 patients (97.7%) who were DIC absent at admission and became DIC positive, within a week (late onset DIC state). The mortality rate was higher in DIC positive compared with pre-DIC (37.6% vs. 22.7%, P < 0.05) or DIC negative (37.6 vs. 13.7%, P < 0.01). It was also significantly higher in pre-DIC compared with DIC negative (P < 0.05). Thus, these modified non-overt DIC diagnostic criteria might therefore be useful for the diagnosis of early-phase DIC. Am. J. Hematol. 85:691-694, 2010. V V C 2010 Wiley-Liss, Inc. IntroductionSeveral diagnostic criteria for disseminated intravascular coagulation (DIC) have been proposed by Colman et al. [1], the Japanese Ministry Health and Welfare (JMHW) [2], and the International Society of Thrombosis and Hemostasis (ISTH) [3], among others. In these diagnostic criteria, global coagulation tests such as the prothrombin time (PT), platelet count, fibrinogen and fibrin and fibrinogen degradation products (FDP) or D-dimer are primarily used for scoring for hemostatic abnormalities. A retrospective study [4] showed that the concordance rate between the JMHW and ISTH diagnostic criteria was 67.4%, and that the ISTH overt-DIC diagnostic criteria were less sensitive for DIC diagnosis than the JMHW criteria. Although the DIC subcommittee of the Scientific Standardized Committee (SSC) in the ISTH emphasized vascular endothelial cell injury as a definition of DIC [3], scoring system based on these three diagnostic criteria do not reflect vascular endothelial cell injury. Recent clinical trials for severe sepsis [5][6][7] showed that the mortality rate of patients with severe sepsis was 35-45% and was even higher in patients with DIC than patients without DIC. The frequency of DIC in patients with severe sepsis was 40.7% according to the KyberSept trial results (antithrombin; AT) [5] and 22.4% in the PROWESS study (recombinant activated protein C; APC) [6]. The patients with severe sepsis have a poor prognosis and the septic patients who also have DIC have an even worse outcome.The treatment efficacy in relation to the JMHW DIC score at the beginning of treatment showed that a greater efficacy was achieved in pre-DIC patients than in DIC patients [8]. The patient prognosis was progressively worse with increasing DIC sc...

Evidence of Disseminated Intravascular Coagulation in a Hemorrhagic Fever with Renal Syndrome—Scoring Models and Severe Illness

“…Recent studies with modifications to the ISTH non-overt DIC scoring show added prediction of poor outcome in patients with sepsis with an addition of an organ system failure scoring, but also discrepancy in the usefulness of added molecular haemostatic markers such as antithrombin [51], [53]. In our study, the trend, although not significant, was that patients received their highest score somewhat earlier with the non-overt template.…”

“…The ISTH overt DIC template has earlier been proposed to miss the diagnosis of early phase of overt DIC (pre-DIC) [36], [53], whereas the ISTH non-overt DIC template has been proposed to identify patients at risk for developing DIC early. Recent studies with modifications to the ISTH non-overt DIC scoring show added prediction of poor outcome in patients with sepsis with an addition of an organ system failure scoring, but also discrepancy in the usefulness of added molecular haemostatic markers such as antithrombin [51], [53].…”

“…Compared to the overt DIC templates with a fibrinogen/CRP-ratio, the non-overt DIC templates performed on par or worse with no added diagnostic value. Recent studies on unsorted patients with underlying conditions related to DIC have evaluated different modifications to the ISTH DIC scoring [36], [51], [53]. In comparison with other accepted scoring criteria for DIC, ISTH overt-DIC diagnostic criteria displayed a high specificity for DIC, was related to a poor patient outcome, and showed high number of associations with DIC in infectious disease [36].…”

Immature platelet fraction predicts coagulopathy-related platelet consumption and mortality in patients with sepsis

“…Accepted criteria for the diagnosis of DIC have some potential weaknesses in the early phase of the disorder [31,32], mainly because they use the platelet count as one of the key components for establishing the diagnosis of DIC. Platelets are consumed over time in the presence of ongoing septic coagulopathy, and it takes several days for the platelet count to fall sufficiently for the diagnostic criteria to be fulfilled.…”

Efficacy evaluation of D‐dimer and modified criteria in overt and nonovert disseminated intravascular coagulation diagnosis

“…Several diagnostic criteria for DIC and nonovert DIC have been proposed by Wada et al [5], Lee et al [6], the ISTH [3], and the Japanese Ministry of Health and Welfare [7]. In these diagnostic criteria, global coagulation tests such as the prothrombin time (PT), blood platelet count (PLT), fibrinogen (Fg), fibrin and fibrinogen degradation products (FDP), or D-dimer (D-D) are primarily used for scoring for hemostatic abnormalities.…”