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Diagnosis of disseminated intravascular coagulation by hemostatic molecular markers
H Wada1, E Gabazza, T Nakasaki
1Second Department of Internal Medicine, Mie University School of Medicine, Tsu-city, Japan.
Insights
Diagnosing disseminated intravascular coagulation (DIC) can be improved by combining thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), and soluble fibrin monomer (sFM) markers. This combination offers a more accurate diagnostic approach for DIC and pre-DIC states.
Area of Science:
- Hematology
- Clinical Diagnostics
- Biochemistry
Background:
- Disseminated intravascular coagulation (DIC) is a complex hematological disorder.
- Accurate and timely diagnosis of DIC is crucial for patient outcomes.
- Existing diagnostic markers for DIC have limitations in sensitivity and specificity.
Purpose of the Study:
- To evaluate the diagnostic utility of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), soluble fibrin monomer (sFM), and D-dimer for DIC.
- To compare the positive rates of these markers in patients with DIC, pre-DIC, and non-DIC states.
- To assess the effectiveness of combining TAT, PPIC, and sFM for DIC diagnosis.
Main Methods:
- Retrospective analysis of plasma samples from 307 DIC, 123 pre-DIC, and 121 non-DIC patients.
- Measurement of plasma levels of TAT, PPIC, sFM, and D-dimer.
- Calculation of positive rates and development of scoring systems based on marker positivity.
Main Results:
- Plasma levels of TAT, PPIC, sFM, and D-dimer were significantly elevated in DIC and pre-DIC groups compared to non-DIC.
- In DIC patients, sFM showed a high positive rate, while D-dimer had a low positive rate.
- A scoring system combining TAT, PPIC, and sFM correctly identified 72% of DIC patients, 17.6% of pre-DIC patients, and 96.6% of non-DIC patients (≤2 points).
Conclusions:
- The combination of TAT, PPIC, and sFM demonstrates significant utility in diagnosing DIC.
- PPIC showed a higher positive rate in patients with hematopoietic malignancy.
- The proposed scoring system using TAT, PPIC, and sFM offers a promising approach for improved DIC diagnosis.
Abstract:
In the present study, the positive rate of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), soluble fibrin monomer (sFM), and D-dimer for the diagnosis of disseminated intravascular coagulation (DIC) was evaluated. The study comprised 307 patients with DIC, 123 with pre-DIC, and 121 with non-DIC. Plasma levels of TAT, PPIC, sFM, and D-dimer were significantly higher in DIC and pre-DIC patients than in non-DIC patients. In DIC patients, the positive rate of sFM was high and that of D-dimer was low; the positive rate of PPIC was higher in patients with hematopoietic malignancy than in those without this disease. In pre-DIC patients, the positive rate of all markers was low (<0.16), and the positive rate of PPIC was relatively high. In non-DIC patients, the positive rate of all hemostatic markers was low (<0.16), that of sFM being the lowest. Scoring the positive rate of TAT, PPIC, and sFM disclosed the following results: 72% of DIC patients had three or more points, 17.6% of pre-DIC patients had three or more points, and almost all (96.6%) non-DIC patients had two or less points. Scoring the positive rate of TAT, PPIC, and D-dimer disclosed the following results: 52.9% of DIC patients and 27.4% of pre-DIC patients had three or more points and almost all (96.7%) non-DIC patients had 2 or less points. These data suggest that the combination of TAT, PPIC, and sFM is useful for making the diagnosis of DIC.