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The diagnosis of DIC: a current overview
Hongyu Yang1, Xiaochun Ma1, Xu Li1
1Department of Critical Care Medicine, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, China.
Insights
Current disseminated intravascular coagulation (DIC) diagnostic criteria are controversial and lack specificity. New criteria are urgently needed to reflect DIC
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.
Abstract:
The name of disseminated intravascular coagulation (DIC) and its diagnostic criteria remain controversial. DIC is a clinical syndrome caused by a variety of etiologies, which determines its high heterogeneity. It is inappropriate to adopt the same diagnostic criteria. DIC has its common characteristics. First, in most DIC, thrombosis and bleeding coexist. Second, DIC is a dynamic process. Third, endothelial cell injury and systemic coagulation activation are the core of DIC. Fourth, DIC is an initiating factor of multiple organ dysfunction syndrome (MODS). There are still controversies about the diagnostic criteria of DIC. First, it relies on clinical manifestations and laboratory tests, which cannot reflect pathophysiology. Second, the clinical manifestations were not sensitive or specific. Third, there is a lack of sensitive biomarkers. Fourth, the parameters in the current diagnostic criteria cannot fully reflect the actual coagulation function. Fifth, it is obviously inappropriate to use the same scoring system for diagnosis of clinical syndromes with different etiologies and pathophysiology. Therefore, it is urgent to re-establish the diagnostic criteria for DIC. In recent years, the understanding of DIC has been continuously improved, including the in-depth understanding of the pathogenesis, the classification of coagulation phenotypes, and the development of the "two-step" diagnosis of DIC, etc. All of these contribute to the establishment of new diagnostic criteria for DIC. In conclusion, it is necessary to develop personalized diagnostic criteria based on etiology, reflecting pathophysiological mechanisms, establishing clear cut-off values for parameters, being clinical applicable, being globally unified, and most importantly, being able to identify therapeutic targets.
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