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Prospective evaluation of three different diagnostic criteria for disseminated intravascular coagulation

Takemitsu Takemitsu1, Hideo Wada, Tsuyoshi Hatada

  • 1Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan.

Thrombosis and Haemostasis
|October 14, 2010
PubMed

Insights

Three diagnostic criteria for disseminated intravascular coagulation (DIC) were evaluated. All systems showed a link to poor patient outcomes, with varying sensitivity and specificity for diagnosing DIC.

Area of Science:

  • Hematology
  • Critical Care Medicine
  • Clinical Diagnostics

Background:

  • Disseminated intravascular coagulation (DIC) diagnosis relies on multiple scoring systems.
  • Established criteria include those from the Japanese Ministry Health and Welfare (JMHW), the International Society on Thrombosis and Haemostasis (ISTH), and the Japanese Association for Acute Medicine (JAAM).
  • The JMHW criteria remain in use within Japan.

Purpose of the Study:

  • To prospectively evaluate and compare the diagnostic performance and prognostic value of three established DIC scoring systems.
  • To assess the utility of haemostatic molecular markers in DIC diagnosis.

Main Methods:

  • Prospective evaluation of 413 patients with various underlying DIC causes at Mie University Hospital.
  • Application of JMHW, ISTH, and JAAM diagnostic criteria to patient cohorts.
  • Statistical analysis of diagnostic criteria performance, including odds ratios for mortality and assessment of key laboratory markers.

Main Results:

  • All three criteria (JMHW, ISTH, JAAM) were significantly associated with poor patient outcomes (odds ratios for death: 1.88, 2.55, 1.99, respectively).
  • Platelet count, prothrombin time, fibrin/fibrinogen degradation products, and fibrinogen levels were crucial for DIC diagnosis across all systems.
  • JAAM criteria demonstrated high sensitivity, while ISTH overt-DIC criteria showed high specificity for DIC diagnosis.
  • Elevated haemostatic molecular markers were consistently observed and proved useful for DIC diagnosis.

Conclusions:

  • All evaluated DIC diagnostic criteria are linked to adverse patient prognoses.
  • The JAAM and ISTH criteria offer distinct advantages in sensitivity and specificity, respectively.
  • Standard laboratory markers and haemostatic markers are vital components in the comprehensive diagnosis of DIC.

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