Use of soluble fibrin antigen instead of D-dimer as fibrin-related marker may enhance the prognostic power of the ISTH overt DIC score

Abstract

The overt DIC score of the DIC subcommittee of the ISTH includes a fibrin-related marker (FRM) as indicator of intravascular fibrin formation. The type of marker to be used has not been specified, but D-dimer antigen, or fibrin degradation products are used by most investigators. Soluble fibrin complexes have been suggested as more specific indicators of acute intravascular fibrin formation. The aim of the present study was to compare the predictive value of the overt DIC score concerning clinical outcome in a surgical intensive care cohort, using either D-dimer antigen, or soluble fibrin antigen as FRM. The cutoff values for 2 and 3 score points for the FRM were assigned on the basis of the 25% and 75% quartiles of 1870 plasma samples obtained from 359 ICU patients during a period of 6 months. For 331 patients with complete diagnostic workup and day 1 blood samples, the Iatro SF as FRM component of the overt DIC score displayed the highest prognostic power concerning clinical outcome. The 28-day mortality of patients with overt DIC at day 1, using Iatro SF as FRM assay was 50.0%, whereas 28-day mortality of patients without overt DIC was 14.0% (p <0.0001). Using MDA D-dimer, and TINAquant D-dimer, 28-day mortality was between 35.5% and 39.3% in patients with overt DIC, and 15.5% to 15.6% in patients without overt DIC. Selection of the FRM as component of the DIC score has a small, but relevant impact on the prognostic performance of the overt DIC score. The present data on the distribution of values may provide a basis for the selection of appropriate cutoff points for assigning 2, and 3 points in the score.

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

“…Studies have also attempted to define D-dimer cutoff levels. One approach assigned scores for moderate and strong increases on 25% and 75% quartiles derived from over 1000 samples in intensive care [12]. Dempfle et al [12] found this to be approximately 1 lg mL )1 and approximately 3 lg mL…”

Longitudinal evaluation of markers of hemostasis in pregnancy

“…In fact, many authors found the increase in D-dimers to be a very sensitive marker of fi brinolytic activity following the formation of fi brin. Some authors suggest that the primary site of increased fi brinolytic activity may be the placental uterine interface, while the elevated levels are due to localized increase in fi brin formation (14,15,16). Variations in protein C activity and levels of antithrombin III were not signifi cant.…”

Utility of the Fibrinogen/C-Reactive Protein Ratio for the Diagnosis of Disseminated Intravascular Coagulation

“…These laboratory criteria for calculating the overt DIC score included a platelet count, a fibrin-related marker, prothrombin time (PT), and fibrinogen. A recent study showed that the DIC scoring system was sufficiently accurate to make or reject a diagnosis of DIC [3] and soluble fibrin antigen improved the prognostic power of the DIC score [4]. …”