[Criteria for diagnosing DIC].

Area of Science:

• Hematology
• Clinical Chemistry

Context:

• Disseminated intravascular coagulation (DIC) is a complex hematological disorder.
• Accurate diagnostic markers are crucial for timely intervention and patient management.

Purpose:

• To evaluate the diagnostic performance of various reagents for prothrombin time (PT), fibrinogen, and fibrinogen degradation products (FDP) in patients with and without DIC.
• To compare the sensitivity and inter-reagent variability of PT ratio, PT-international normalized ratio (PT-INR), and FDP assays for DIC detection.
• To assess the concordance between the International Society of Thrombosis and Haemostasis (ISTH) overt-DIC criteria and the Japanese Ministry of Health and Welfare (JMHW) DIC criteria.

Summary:

• Significant differences in PT reagent sensitivity were observed, with PT-INR demonstrating higher sensitivity and lower inter-reagent variability for DIC detection compared to the PT ratio.
• Fibrinogen assays showed minimal differences between reagents but limited diagnostic utility for DIC.
• FDP assays exhibited good sensitivity for DIC, but marked inter-reagent variability necessitates standardization.
• The ISTH overt-DIC criteria showed approximately 70% concordance with JMHW criteria, primarily identifying typical DIC cases.

Impact:

• Standardization of PT and FDP reagents is recommended to improve diagnostic accuracy and consistency in DIC detection.
• The findings highlight the potential clinical importance of non-overt DIC diagnostic criteria in future patient management.
• PT-INR emerges as a more reliable parameter than PT ratio for DIC diagnosis due to its higher sensitivity and reagent consistency.