Analysis of D-dimer cut-off values for overt DIC diagnosis in exertional heat illness

Area of Science:

• Critical Care Medicine
• Hematology
• Environmental Medicine

Background:

• The International Society on Thrombosis and Haemostasis (ISTH) scoring system is utilized for diagnosing overt disseminated intravascular coagulation (DIC).
• Optimal cut-off points for fibrin-related markers in DIC diagnosis remain incompletely defined.
• Exertional heat illness (EHI) can lead to severe complications, including DIC.

Purpose of the Study:

• To evaluate the predictive capability of the ISTH DIC score and the Multiple Organ Dysfunction (MODS) score for mortality in patients with EHI.
• To assess the impact of three different D-dimer cut-off values on the ISTH DIC score's performance in predicting mortality.

Main Methods:

• A retrospective analysis of 76 hospitalized EHI patients was conducted.
• The ISTH DIC score was calculated using three distinct D-dimer cut-off values on the first day of hospitalization.
• The predictive accuracy of the DIC score and MODS score for mortality was assessed using receiver operating characteristic (ROC) curves.

Main Results:

• The ISTH DIC score demonstrated a certain predictive power for poor outcomes in EHI patients.
• One D-dimer cut-off value yielded higher specificity (89%) for the DIC score compared to others.
• The MODS score exhibited a superior area under the ROC curve (0.927) for mortality prediction compared to the DIC scores (0.838-0.85).

Conclusions:

• The ISTH DIC score, with varying D-dimer cut-offs, has prognostic value in EHI.
• The MODS score appears to be a more robust predictor of mortality in EHI patients than the ISTH DIC score.
• These findings provide a reference for selecting appropriate D-dimer cut-off points for the ISTH DIC score in the context of EHI.