Diagnosis and Prognosis of Overt Disseminated Intravascular Coagulation in a General Hospital: Meaning of the ISTH Score System, Fibrin Monomers, and Lipoprotein‐C Reactive Protein Complex Formation

Abstract

The meaning, the utility, and the prognostic significance of the International Society of Thrombosis and Hemostasis overt disseminated intravascular coagulation (DIC) score and other parameters of coagulation activation including soluble fibrin monomer complexes (SFMC), antithrombin and protein C consumption, and formation of lipoprotein-C-reactive protein (LP-CRP) complexes (MDA slope 1 and flag A2) were evaluated in 165 inpatients from a general hospital for whom DIC testing was required by the attending physicians.Of these 165 patients, 148 had an underlying disease that clearly justified the laboratory request from our systematic post hoc review of the clinical charts. Of these 148 patients, 28 had a positive overt DIC score, 19 had an A2 flag, and 4 had both. The DIC score was strongly related to several major markers of coagulation activation such as D-dimers, thrombin-antithrombin complexes, and soluble fibrin and was inversely related to antithrombin and protein C levels, which began to fall from DIC score 4 or higher. The formation of LP-CRP complexes was only related to Gram-negative sepsis and these patients had a strong inflammatory reaction. Independent risk factors for death were high creatininemia, positive overt DIC score, and/or presence of SFMC. In patients with positive DIC score, SFMC positivity and low levels of antithrombin and/or protein C were additional risk factors.The ISTH overt DIC score proves useful and adequate as a marker for clinically significant DIC. Illness severity is further defined by SFMC, antithrombin, and protein C levels. LP-CRP complexes are related to sepsis but not to actual overt DIC and lethal prognosis. Am. J.

ADAMTS‐13 activity can predict the outcome of disseminated intravascular coagulation in hematologic malignancies treated with recombinant human soluble thrombomodulin

“…Previous studies have proposed that, in addition to ADAMTS‐13 activity, the levels of AT‐III, SF, Fib, HMGB1, protein C, TM, and PIC can help predict the prognosis of DIC without rTM treatment [24–30]. Although most of those coagulation markers were also abnormal before treatment in our series, they were not predictive of the outcome for DIC treated with rTM.…”

The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5‐year overview

“…Increasing scores strongly correlated with mortality. Others have similarly confirmed this independent prediction of mortality by the ISTH DIC score and its added prognostic value to the Acute Physiology and Chronic Health Evaluation (APACHE) II system [7][8][9].…”

Guidelines for the diagnosis and management of disseminated intravascular coagulation

“…A strong correlation between an increasing DIC score and mortality has been demonstrated by several studies, For each DIC point, increases in the odds of mortality of 1·25–1·29 have been demonstrated (Bakhtiari et al , 2004). Several other studies have similarly confirmed that the presence of overt DIC by the ISTH algorithm is independently predictive of mortality (Gando et al , 2005; Sivula et al , 2005; Cauchie et al , 2006). These studies show that patients with sepsis and DIC, according to the scoring system, have a significantly higher mortality of 43%, as compared with 27% in patients without DIC.…”