of Thrombosis Hemostasis/DIC subcommittee Diagnostic criteria for non-overt disseminated intravascular coagulation (DIC) have been proposed by the International Society of Thrombosis and Hemostasis, but are not useful for the diagnosis of early phase of overt-DIC (pre-DIC). Therefore, in the current study the non-overt DIC diagnostic criteria were modified using the global coagulation tests, the change rate in the global coagulation tests and molecular hemostatic markers to detect the pre-DIC state and were prospectively evaluated in 613 patients with underlying DIC disease. The frequencies of patients with DIC (DIC positive), late onset DIC, and without DIC (DIC absent) were 29.5%, 7.2%, and 63.3%, respectively. The modified non-overt-DIC criteria can correctly predict 43/44 patients (97.7%) who were DIC absent at admission and became DIC positive, within a week (late onset DIC state). The mortality rate was higher in DIC positive compared with pre-DIC (37.6% vs. 22.7%, P < 0.05) or DIC negative (37.6 vs. 13.7%, P < 0.01). It was also significantly higher in pre-DIC compared with DIC negative (P < 0.05). Thus, these modified non-overt DIC diagnostic criteria might therefore be useful for the diagnosis of early-phase DIC. Am. J. Hematol. 85:691-694, 2010. V V C 2010 Wiley-Liss, Inc.
IntroductionSeveral diagnostic criteria for disseminated intravascular coagulation (DIC) have been proposed by Colman et al. [1], the Japanese Ministry Health and Welfare (JMHW) [2], and the International Society of Thrombosis and Hemostasis (ISTH) [3], among others. In these diagnostic criteria, global coagulation tests such as the prothrombin time (PT), platelet count, fibrinogen and fibrin and fibrinogen degradation products (FDP) or D-dimer are primarily used for scoring for hemostatic abnormalities. A retrospective study [4] showed that the concordance rate between the JMHW and ISTH diagnostic criteria was 67.4%, and that the ISTH overt-DIC diagnostic criteria were less sensitive for DIC diagnosis than the JMHW criteria. Although the DIC subcommittee of the Scientific Standardized Committee (SSC) in the ISTH emphasized vascular endothelial cell injury as a definition of DIC [3], scoring system based on these three diagnostic criteria do not reflect vascular endothelial cell injury. Recent clinical trials for severe sepsis [5][6][7] showed that the mortality rate of patients with severe sepsis was 35-45% and was even higher in patients with DIC than patients without DIC. The frequency of DIC in patients with severe sepsis was 40.7% according to the KyberSept trial results (antithrombin; AT) [5] and 22.4% in the PROWESS study (recombinant activated protein C; APC) [6]. The patients with severe sepsis have a poor prognosis and the septic patients who also have DIC have an even worse outcome.The treatment efficacy in relation to the JMHW DIC score at the beginning of treatment showed that a greater efficacy was achieved in pre-DIC patients than in DIC patients [8]. The patient prognosis was progressively worse with increasing DIC sc...