The diagnosis of DIC: a current overview

Area of Science:

• Hematology
• Pathophysiology
• Clinical Diagnostics

Background:

• Disseminated intravascular coagulation (DIC) is a complex syndrome with diverse etiologies and high heterogeneity.
• Existing diagnostic criteria for DIC are controversial due to reliance on non-specific clinical signs and laboratory tests, failing to capture underlying pathophysiology.
• Current criteria lack sensitive biomarkers and adequate parameters to reflect true coagulation function, leading to inappropriate application across different clinical scenarios.

Purpose of the Study:

• To highlight the limitations and controversies surrounding current diagnostic criteria for disseminated intravascular coagulation (DIC).
• To emphasize the urgent need for re-establishing diagnostic criteria for DIC.
• To advocate for the development of new, personalized diagnostic criteria for DIC.

Main Methods:

• Review and critical analysis of existing literature on disseminated intravascular coagulation (DIC) diagnosis.
• Examination of the common characteristics of DIC, including coexisting thrombosis and bleeding, dynamic nature, endothelial injury, and role in multiple organ dysfunction syndrome (MODS).
• Discussion of recent advancements in understanding DIC pathogenesis, coagulation phenotypes, and diagnostic approaches, such as the 'two-step' diagnosis.

Main Results:

• Current DIC diagnostic criteria are inadequate as they do not fully reflect pathophysiology, lack sensitive biomarkers, and are not specific.
• The heterogeneity of DIC etiologies makes a single scoring system inappropriate for diagnosis.
• Recent progress in understanding DIC pathogenesis and diagnostic methodologies provides a foundation for developing improved criteria.

Conclusions:

• There is a critical need to develop new, personalized diagnostic criteria for disseminated intravascular coagulation (DIC).
• Future criteria should be based on etiology, reflect pathophysiological mechanisms, have clear cut-off values, be clinically applicable, and globally unified.
• The ultimate goal of new DIC diagnostic criteria is to effectively identify therapeutic targets.