A Revised Fibrinogen Cutoff Value in the Chinese Disseminated Intravascular Coagulation Scoring System May Provide a Better Prognostic Value for Hematological Malignancies

Abstract

To retrospectively validate the prognostic value of the latest Chinese disseminated intravascular coagulation (DIC) scoring system (CDSS) in hematological malignancies, 260 patients with confirmed hematological malignancies and suspected DIC in West China Hospital between 2011 and 2015 were included in this study. We evaluated via univariate and multivariate analyses the diagnostic biomarkers, and the cutoff levels used in the CDSS, except those for fibrinogen, were found to be valid. In subgroup analyses, the value of fibrinogen was found to be mainly unfit for the acute promyelocytic leukemia group. Forty-six patients (17.7%) had elevated fibrinogen levels (>4 g/L) and tended to have a poor prognosis, and thus we redetermined the cutoff value of fibrinogen (<1 g/L or >4 g/L was defined as abnormal). As a result, all of the markers used in the CDSS had prognostic value (including for the promyelocytic leukemia group); meanwhile, this modification also resulted in a larger area under the receiver operating characteristic curve compared to the CDSS and the International Society on Thrombosis and Haemostasis score. We believe that, with regard to prognosis prediction, this cutoff value modification for fibrinogen is preferable for DIC patients with a tendency toward severe hypofibrinogenemia. However, a multicenter, prospective study is needed to validate this possibility.

Usefulness of two clinical (CBC and PETHEMA) scores for predicting early death in patients with acute promyelocytic leukemia: A single-center study in Mexico City

“…In this research, a value of 350 mg/dL was associated with an increased risk of premature death (OR 3.525, p = 0.013). These data are similar to those reported by Wei et al, in which the presence of an elevated level of fibrinogen (> 400 mg/dL) was associated with an adverse prognosis in different hematological malignancies including APL 30 . Conversely, Mantha et al analyzed several factors that were associated with premature death in five clinical trials that included the use of ATRA during induction.…”

Coagulación intravascular diseminada

“…La CID se define como un trastorno adquirido de la hemostasia secundario a un cuadro clínico subyacente, se caracteriza por la activación sistémica de la coagulación y una fibrinólisis endógena inadecuada que da como resultado la formación de fibrina intravascular 5,9,10 . La trombina circulante hace que se formen microtrombos en vasos sanguíneos pequeños y trombos en vasos sanguíneos medianos y grandes, lo que finalmente produce hipoxia de los tejidos 11 .…”