Evaluation of the International Society on Thrombosis and Haemostasis and Institutional Diagnostic Criteria of Disseminated Intravascular Coagulation in Pediatric Patients

Abstract

Globally, adult intensive care units routinely use the International Society on Thrombosis and Haemostasis (ISTH) scoring system for identifying overt disseminated intravascular coagulation (DIC). However, in our pediatric intensive care unit, a modified diagnostic criterion (Texas Children’s Hospital [TCH] criteria) that requires serial monitoring of the coagulation variables is employed. A retrospective analysis of 2,136 DIC panels from 130 patients who had at least 4 DIC panels during 1 admission to a pediatric intensive care unit was done to compare the diagnostic utility of the TCH criteria with the ISTH scoring method in children. Both scoring systems were evaluated against the gold standard diagnostic method of autopsy confirmation of DIC in the subset of children who died. Receiver operating characteristic analysis indicates that TCH diagnostic criteria are comparable to the ISTH scoring method (area under the curve of 0.878 for TCH and 0.950 for ISTH). On the contrary, TCH diagnostic criteria perform better, with a sensitivity significantly higher than the ISTH scoring method when tested against the gold standard (P < .05). Fibrinogen is not a significant predictor of overt DIC in both models. Sequential testing of coagulation parameters is recommended for improved sensitivity when applying ISTH criteria to pediatric populations.

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

“…Not a few studies of DIC caused mainly by infections have concluded that fibrinogen should be excluded from DIC scoring systems [15,16,17]. In those studies of mainly infection-related DIC, decreases in fibrinogen were rare, primarily because fibrinogen is an acute-phase protein and its plasma level increases during the acute-phase response, especially in inflammatory conditions [15,17]. In contrast, in hematological malignancy-related DIC patients, hypofibrinogenemia is not rare.…”

Disseminated intravascular coagulation in paediatrics

“…DIC is a clinico-laboratory diagnosis 4. The diagnosis is considered only in patients with an underlying disorder, which is known to be associated with DIC in conjunction with several laboratory features.…”

“…2 The criteria have 91% sensitivity with 97% specificity among adults and demonstrated strong correlation between DIC score with incidence of mortality 18. Unfortunately, data on validation of ISTH DIC criteria in children are limited, even though it has been used universally in paediatric patients 4. Furthermore, to our knowledge no studies have evaluated the sensitivity and specificity of ISTH DIC criteria in neonates.…”

“…The ISTH diagnostic scoring system for DIC has been used widely in adult intensive care units (ICU), but controversies exist in paediatric population in relation to normal range for laboratory parameters and choice of diagnostic coagulation tests 4. This review article focuses on the pathogenesis, diagnostic tests and principles of management of DIC in children.…”

Evaluation of Vitamin E, Selenium and Glutathione Peroxidase Activity in Patients with Disseminated Intravascular Coagulation

“…Etiyolojide sepsis, vaskülit, hipoksi, travma, uygunsuz kan transfüzyonları, dev hemanjiomlar ve başlıca akut promiyelositik lösemi olmak üzere maligniteler yer alır (4)(5)(6). Endotelyal hasar ve mikrovasküler tromboza zemin hazırlayan nedenler arasında artmış serbest oksijen radikallerinin varlığı ve lipid peroksidasyonu sonucu oluşan endotel disfonksiyonu sorumlu tutulmaktadır (7). Reaktif oksijen türlerine karşı enzimatik korumayı sağlayan, protein oksidasyonu ve DNA'daki hasarı önleyen süperoksit dismutaz, katalaz, glutatyon peroksidaz, glutatyon redüktaz gibi çeşitli enzim sistemleri vardır.…”