Prospective evaluation of three different diagnostic criteria for disseminated intravascular coagulation

Abstract

There are three different diagnostic score systems for disseminated intravascular coagulation (DIC) established by the Japanese Ministry Health and Welfare (JMHW), the International Society on Thrombosis and Haemostasis (ISTH) and the Japanese Association for Acute Medicine (JAAM). The JMHW criteria are still used in Japan. In the present study, all three diagnostic criteria were used to prospectively evaluate 413 patients with different underlying diseases of DIC who were treated at the Mie University Hospital (JMHW, n= 166; ISTH, n=143; JAAM, n=291). The odds ratio (95% confidence interval) for death was 1.88 (1.22 - 2.90) in JMHW, 2.55 (1.65 - 3.95) in ISHT and 1.99 (1.19 - 3.32) in JAAM. The platelet count, prothrombin time, fibrin and fibrinogen degradation products and fibrinogen were significantly important for diagnosis of DIC by all three diagnostic criteria. Haemostatic molecular markers were significantly high in all patients and were useful for the diagnosis of DIC. The JAAM diagnostic criteria displayed a high sensitivity for DIC and the ISTH overt-DIC diagnostic criteria displayed a high specificity for DIC. All three diagnostic criteria for DIC were related to a poor patient outcome.

Management of disseminated intravascular coagulation: A survey of the International Society on Thrombosis and Haemostasis

“…The sparse use of diagnostic scores may be the consequence of their limited validation among populations of different ethnicities or various conditions underlying DIC, the emerging role of dynamic scores, or the uncertain reliability of these scores in the absence of a reference standard. A number of studies found that increasing values of the scores of the ISTH, Japanese Ministry of Health and Welfare, or of the Japanese Association for Acute Medicine Additional predict a worse outcome, which may increase their clinical usefulness and applicability [6][7][8][9][10]. This prognostic value and the possibility to identify DIC patients who may benefit from additional diagnostic and/or therapeutic procedures need further confirmation and direct comparison against dynamic scores [11].…”

A Proposal of the Modification of Japanese Society on Thrombosis and Hemostasis (JSTH) Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Sepsis-Associated DIC

“…Table 1 shows the [5][6][7], P < .001). The platelet count was lower (P < .01), the PT ratio was higher (P < .001), and the antithrombin activity was lower in the non-survivors (P < .001).…”

A Prospective Analysis of Disseminated Intravascular Coagulation in Patients with Infections

“…These diagnostic criteria include global coagulation tests, such as the assessment of the prothrombin time (PT), the platelet count and the levels of fibrinogen, fibrin and fibrinogen degradation products (FDP) and Ddimer, to score hemostatic abnormalities. These diagnostic criteria tend to focus on septic DIC; however, their efficacy remains insufficient (18). Concordance in the diagnosis of DIC between the JMHW and ISTH overt-DIC diagnostic criteria is relatively high among patients with infections and low in patients with hematopoietic tumors (19).…”