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Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: A
Yingying Wu1, Lili Luo1, Ting Niu2
1Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.
Insights
The Chinese DIC Scoring System (CDSS) offers improved diagnosis and mortality prediction for disseminated intravascular coagulation (DIC) compared to existing methods. This validated system demonstrates high accuracy and is recommended for clinical use.
Area of Science:
- Critical Care Medicine
- Hematology
- Clinical Diagnostics
Background:
- Disseminated intravascular coagulation (DIC) is a severe complication in critically ill patients.
- Accurate diagnosis of DIC is crucial for timely intervention.
- Existing scoring systems like ISTH, JAAM, and JMHW aid DIC diagnosis.
Purpose of the Study:
- To prospectively evaluate the newly proposed Chinese DIC Scoring System (CDSS).
- To compare the diagnostic and prognostic performance of CDSS against established DIC scoring systems.
- To assess CDSS's ability to predict 28-day mortality and reflect illness severity.
Main Methods:
- Prospective, multi-center study conducted across 18 sites in China over one year.
- Utilized Receiver Operating Characteristic (ROC) curves to analyze diagnostic accuracy and mortality prediction.
- Compared CDSS performance against ISTH, JAAM, and JMHW scoring systems.
Main Results:
- CDSS demonstrated superior diagnostic and prognostic performance (larger AUCs) compared to ISTH and JAAM.
- CDSS showed better performance than JMHW for ISTH-defined DIC in non-infectious diseases.
- All CDSS AUCs exceeded 0.8, indicating high sensitivity and specificity; it independently predicted mortality and correlated with illness severity.
Conclusions:
- The Chinese DIC Scoring System (CDSS) exhibits significant diagnostic and prognostic value for DIC.
- CDSS offers improved accuracy and reliability over existing scoring systems.
- The study recommends the promotion and adoption of CDSS in clinical practice for better DIC management.
Abstract:
Disseminated intravascular coagulation (DIC) is a common life-threatening complication in critically ill patients. The diagnostic scoring systems of DIC enable a more prompt and accurate diagnosis of DIC, such as the International Society on Thrombosis and Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry of Health and Welfare (JMHW). This study prospectively evaluated the newly proposed Chinese DIC Scoring System (CDSS), which was conducted at 18 centers in China during a one-year period. Receiver operating characteristic (ROC) curves showed that, for diagnosis of DIC and for prediction of the 28-day all-cause mortality, the CDSS had larger areas under the ROC curve (AUCs) than the ISTH and the JAAM in different groups. The CDSS also had larger AUC than the JMHW for the ISTH DIC in non-infectious diseases. All of the AUCs of the CDSS were greater than 0.8, accompanied with both high sensitivity and high specificity. Furthermore, the CDSS score was an independent predictor of mortality (odds ratio, 1.882; p < 0.001), and could reflect the illness severity (p < 0.001 for Spearman's rank correlations with the scores of severity). In conclusion, the CDSS is worthy of promotion with a better diagnostic and prognostic value for DIC.
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