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Modified score for disseminated intravascular coagulation in the critically ill
Mirka Sivula1, Minna Tallgren, Ville Pettilä
1Intensive Care Unit, Division of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, P.O. Box 340, 00029 Helsinki, Finland. mirka.sivula@hus.fi
Insights
The International Society on Thrombosis and Haemostasis (ISTH) criteria for overt disseminated intravascular coagulation (DIC) did not independently predict mortality in intensive care unit (ICU) patients. However, antithrombin levels show promise for diagnosing overt DIC.
Area of Science:
- Critical Care Medicine
- Hematology
- Clinical Pathology
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome with significant mortality in intensive care units (ICUs).
- The International Society on Thrombosis and Haemostasis (ISTH) developed criteria for diagnosing overt DIC.
- The predictive value of overt DIC diagnosis and its components for mortality in ICU patients requires further evaluation.
Purpose of the Study:
- To evaluate the diagnostic utility of ISTH criteria for overt DIC.
- To assess the predictive value of ISTH score components for 28-day mortality in ICU patients.
- To identify reliable indicators for overt DIC diagnosis in critically ill patients.
Main Methods:
- Retrospective study of 494 ICU patients.
- Analysis of clinical and laboratory data, including hemostatic parameters.
- Evaluation of ISTH criteria and individual parameter performance using area under the curve (AUC).
Main Results:
- 19% of patients met criteria for overt DIC, with higher 28-day mortality (40% vs. 16%).
- Lowest platelet count (AUC 0.910) and highest D-dimer (AUC 0.846) were strong predictors of overt DIC.
- Plasma antithrombin (AUC 0.823) also showed good discriminative power, while fibrinogen (AUC 0.690) had poor predictive value.
Conclusions:
- Overt DIC diagnosis by ISTH criteria was not an independent predictor of 28-day mortality.
- Plasma antithrombin is a potential indicator for overt DIC diagnosis in ICU settings.
- The role of plasma fibrinogen in overt DIC diagnosis requires further investigation.
Objective:
To assess the value of the diagnosis of overt disseminated intravascular coagulation (DIC) according to the International Society on Thrombosis and Haemostasis (ISTH) criteria and that of the parameters included in the ISTH score for overt DIC in predicting day 28 mortality in intensive care patients. Also, to assess the value of the components of the score in the diagnosis of overt DIC.
Design And Setting:
Retrospective clinical study in a university hospital intensive care unit.
Patients And Participants:
494 consecutive patients admitted in the ICU between January 2002 and October 2003.
Measurements And Results:
Clinical and laboratory data, including hemostatic parameters, were collected from computerized databases and patient files. Altogether 19% (95/494) of the patients fulfilled the criteria for overt DIC. Their day 28 mortality rate was higher than that of patients without overt DIC (40% vs. 16%). The lowest platelet count (area under curve, AUC, 0.910), highest plasma D-dimer (AUC 0.846), lowest antithrombin (AUC 0.823), and Owren-type prothrombin time activity (AUC 0.797) discriminated well the patients with and without overt DIC, whereas plasma fibrinogen (AUC 0.690) had poor discriminative power. No patient with the diagnosis of overt DIC had decreased plasma fibrinogen. Day-1 SOFA and APACHE II score, the first CRP measurement, and the lowest antithrombin were independent predictors of day 28 mortality.
Conclusions:
The diagnosis of overt DIC was not an independent predictor of day 28 mortality. In ICU patients plasma antithrombin seems a promising candidate in the panel of indicators for overt DIC whereas the value of plasma fibrinogen is in doubt.
