Related Experiment Videos
[Diagnosis of DIC based on evidence]
Hideo Wada1, Junji Nishioka, Tsutomu Nobori
1Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Tsu.
Insights
Diagnosing disseminated intravascular coagulation (DIC) requires simpler methods. Current criteria have trade-offs, and molecular markers could improve accuracy, especially in infectious diseases.
Area of Science:
- Hematology
- Pathophysiology
- Clinical Diagnostics
Context:
- Disseminated intravascular coagulation (DIC) diagnosis has evolved from microthrombi detection to complex laboratory assessments.
- Existing diagnostic criteria, including those from the International Society of Thrombosis Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM), utilize scoring systems based on global coagulation tests.
- Comparative analysis using ROC curves indicates similar diagnostic performance but differing sensitivity and specificity profiles among the current criteria.
Purpose:
- To evaluate the diagnostic efficacy of existing criteria for disseminated intravascular coagulation (DIC).
- To explore the potential of molecular hemostatic markers for enhancing DIC diagnostic accuracy.
- To advocate for the development and validation of new, simplified DIC diagnostic criteria.
Summary:
- The diagnosis of DIC relies on laboratory tests assessing hemostatic abnormalities, with established criteria from ISTH, JAAM, and Japanese Ministry Health and Welfare showing comparable diagnostic abilities but varying sensitivity and specificity.
- Molecular markers like thrombin antithrombin complex and D-dimer show promise for improving diagnostic precision.
- Further research, including prospective studies in infectious diseases utilizing molecular markers, is recommended to refine and simplify DIC diagnosis.
Impact:
- Highlights the need for improved diagnostic strategies for DIC.
- Suggests specific molecular markers as key components for future diagnostic criteria.
- Emphasizes the importance of prospective studies for validating new diagnostic approaches in relevant clinical settings.
Abstract:
The diagnosis of disseminate intravascular coagulation (DIC) was first based on the detection of microthrombi, but it currently involves analysis of hemostatic abnormalities by various laboratory tests and further studies are needed to simplify diagnosis of DIC. There are three diagnostic criteria for DIC developed by the International Society of Thrombosis Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry Health and Welfare. These diagnostic criteria consist of the scoring system by the same global coagulation tests. From ROC analysis, the ability for diagnosis of DIC is similar among three diagnostic criteria. ISTH diagnostic criteria has high specificity and low sensitivity, but JAAM criteria has low specificity and high sensitivity. Several molecular hemostatic markers such as thrombin antithrombin complex, D-dimer, soluble fibrine (SF) and plasmin-plasmin inhibitor complex have to be adopted for further improvement of diagnostic criteria for DIC. Finally, prospective study for new diagnostic criteria for DIC should be carried out in infectious diseases by molecular hemostatic markers.