The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5‐year overview

Toh, Cheng‐Hock; Hoots, W. Keith

doi:10.1111/j.1538-7836.2007.02313.x

Cited by 335 publications

(254 citation statements)

References 16 publications

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“…The patient prognosis was progressively worse with increasing DIC score, suggesting that early diagnosis and early treatment are essential for improving the patient outcome. Therefore, additional diagnostic criteria for non-overt DIC were proposed by the ISTH/SSC subcommittee in order to diagnose early-phase DIC, but these criteria were not well-established [9][10][11][12]. Hemostatic molecular markers such as the thrombin AT complex (TAT), soluble fibrin, and the plasmin-plasmin inhibitor complex, among others, were reported to be markers for the early phase of DIC [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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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...

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Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…Accordingly, prothrombin time (PT) and partial thromboplastin time (PTT) are close to normal values or prolonged, whereas thrombin-antithrombin complex (TAT) (which indicates in vivo thrombin formation) and D-dimers (which are a marker of in vivo fibrinolysis) are often elevated, and thrombocytopenia is a usual finding 12 -21 . This laboratory profile is compatible with disseminated intravascular coagulation (DIC), which is diagnosed according to a score defined by the International Society of Thrombosis and Haemostasis (ISTH) 22 . The scoring system takes into account i) platelet count, ii) elevated fibrin related markers, iii) prolonged prothrombin time, and iv) fibrinogen level 22 23 .…”

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confidence: 99%

“…Bleeding is more common in overt DIC, but it is not needed for the formal diagnosis 22 23. In other words, absence of bleeding in P. falciparum-infected patients does not exclude the presence of DIC in this same population; actually, most of these patients meet the criteria for DIC as defined above 22 . Unfortunately, absence of bleeding is often mistakenly regarded as the reason why DIC is supposedly not present in malaria.…”

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confidence: 99%

Does activation of the blood coagulation cascade have a role in malaria pathogenesis?

Francischetti

2008

Trends in Parasitology

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Plasmodium falciparum infection is often associated with a procoagulant state. Recent identification of tissue factor (TF) in the brain endothelium of patients who died from cerebral malaria casts new light in our understanding of the coagulation disorder found in P. falciparum infection. It has also been revealed that parasitized red blood cells (pRBC) support assembly of multimolecular coagulation complexes. In this article, the role of TF expression by the endothelium and amplification of the coagulation cascade by pRBC and/or activated platelets-particularly at sequestration sitesis discussed as crucial events in mounting and sustaining a coagulation-inflammation cycle that contributes to organ dysfunction and coma in P. falciparum malaria. Blood coagulation and malariaMalaria caused by P. falciparum remains a highly endemic disease; it has been estimated that at least one million deaths occur every year. Children are at high risk, and often severe malaria (severe anemia or cerebral malaria [CM]) is the cause of death in this population 1-4. P. falciparum infection is associated with sequestration 5 -8 , endothelial cell (EC) activation 8-10, increase in inflammatory cytokines 3 , 11, and activation of the coagulation cascade 12 -20. Despite several papers devoted to the coagulation disorder in malaria-many of them published during the 1970s and 1980s (reviewed in Ref. 20)-the mechanism that triggers and propagates the coagulation activation in P. falciparum infection has remained elusive. These studies, however, demonstrated that bleeding and/or hemorrhage are typically not present, although laboratory tests indicate a certain degree of in vivo blood coagulation activation 12 -20 . Accordingly, prothrombin time (PT) and partial thromboplastin time (PTT) are close to normal values or prolonged, whereas thrombin-antithrombin complex (TAT) (which indicates in vivo thrombin formation) and D-dimers (which are a marker of in vivo fibrinolysis) are often elevated, and thrombocytopenia is a usual finding 12 -21 . This laboratory profile is compatible with disseminated intravascular coagulation (DIC), which is diagnosed according to a score defined by the International Society of Thrombosis and Haemostasis (ISTH) 22 . The scoring system takes into account i) platelet count, ii) elevated fibrin related markers, iii) prolonged prothrombin time, and iv) fibrinogen level 22 23 . Depending on the score punctuation, levels < 5 are suggestive of non-overt (compensated) DIC while scores > or = 5 are compatible with overt (decompensated) DIC. Bleeding is more common in overt DIC, but it is not needed for the formal diagnosis 22 23. In other words, absence of bleeding in P. falciparum-infected patients does not exclude the presence of DIC in this same population; actually, most of these patients meet the criteria for DIC as defined above 22 . Unfortunately, absence of bleeding is often mistakenly regarded as the reason why DIC is supposedly not present in malaria. Further, some reports do not support the view that coa...

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“…It is a clinical-pathological diagnosis, in which the disordered haemostasis predominantly occurs in the microvasculature [8]. An infectious organism produces the immune response, which leads to the generation of pro-inflammatory cytokines.…”

Section: Pathophysiologymentioning

confidence: 99%

The management of abnormal haemostasis in the ICU

Retter

Barrett

2014

Anaesthesia

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SummaryThe aetiology and management of haemostatic abnormalities in critical care patients are considered in this narrative review. The mechanisms of normal haemostasis and derangements that occur as a result of sepsis and organ dysfunction are discussed. Finally, the management of haemostatic abnormalities as they relate to critical care practice are considered, including the management of heparin‐induced thrombocytopenia.

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The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5‐year overview

Cited by 335 publications

References 16 publications

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

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

Does activation of the blood coagulation cascade have a role in malaria pathogenesis?

The management of abnormal haemostasis in the ICU

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