Retrospective Evaluation of New Chinese Diagnostic Scoring System for Disseminated Intravascular Coagulation

Wang, Manzhi; Kou, Haiming; Deng, Jun; Wang, Huafang; Guo, Tao; Mei, Heng; Hu, Yu

doi:10.1371/journal.pone.0129170

Cited by 18 publications

(18 citation statements)

References 21 publications

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“…Under severe coagulopathy circumstances, such as DIC, patients may easily die without early diagnosis and proper treatment. From experience of dealing with CRS-related coagulopathy, we recommend CDSS [33] as an applicable tool for better diagnosis and management of DIC. As long as any coagulopathy manifestation arises, DIC grading should be carried out every day so as to confirm the start and end time point of DIC and to dynamically monitor the severity of DIC.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, the CRS was graded and managed in accordance with the modified CRS grading system [32] and was judged to be severe if it was grade 3 or higher. Additionally, DIC was diagnosed by using the new Chinese DIC Scoring System (CDSS) [33], which was widely used in China and showed good performance on diagnostic and prognostic value in Chinese population [34,35].…”

Section: Clinical Trial Designmentioning

confidence: 99%

“…Among the 30 patients who had coagulation problems, 15 were further diagnosed as DIC in line with CDSS [33] ( Table 3). The symptoms of DIC varied from mild and selflimiting, with ecchymosis and jaundice, to severe and life-threatening, with hypotension, dyspnea, renal dysfunction, neurological disorders, and even shock (Table 4).…”

Section: Fifteen Patients Diagnosed As Dic According To Chinese Dic Smentioning

confidence: 99%

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Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy

et al. 2019

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The CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy has been widely proved effective on relapsed and refractory (r/r) B cell acute lymphoblastic leukemia (B-ALL). Meanwhile, CAR-T therapy-related toxicities, including cytokine release syndrome (CRS) and neurological toxicities, are drawing researchers' attention. In addition, our research team notices that coagulopathy and even disseminated intravascular coagulation (DIC) are common problems during CAR-T therapy. In our phase 1/2 clinical trial (NCT02965092), 53 r/r B-ALL patients underwent leukapheresis on day − 11 and received lymphodepleting chemotherapy on day − 7 to day − 5. Finally, they received split infusions of anti-CD19 CAR-T cells on day 0 to day 2. Plasma concentrations of tissue factor (TF) and platelet endothelial cell adhesion molecular-1 (PECAM-1) were also measured to identify the mechanism of coagulation disorders. The overall 1-month remission rate of the 53 patients was 88.7%. During the treatment course, 19 patients experienced grade 3-4 CRS, 8 patients developed grade 2-3 neurological toxicities. Beyond that, 30 patients (30/53, 56.6%) suffered from coagulation disorders, and half of them should be diagnosed as DIC. Benefiting from replacement and anticoagulant therapy, 14 patients successfully got out of the conditions of DIC. Remarkably, the severity of coagulopathy was positively correlated with CRS grade. What is more, plasma TF and PECAM-1 levels indicated that vascular endothelial factors played key roles in the process of CRS-related coagulopathy. To conclude, coagulation disorders frequently happen during CAR-T therapy. TF and PECAM-1 are of great importance in the etiology and pathogenesis of coagulation problems. Early and proper interventions targeted at CRS-related coagulopathy contribute a lot to the control of side effects in CAR-T therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Trial Designmentioning

confidence: 99%

Section: Fifteen Patients Diagnosed As Dic According To Chinese Dic Smentioning

confidence: 99%

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Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy

et al. 2019

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“…The JMHW criteria were the first DIC criteria and were established in Japan; however, the global standard for the diagnosis of DIC should probably be the ISTH overt‐DIC criteria . As DIC is a common and serious condition, various diagnostic criteria have been released other than the two above‐mentioned criteria, causing further confusion Thus, the establishment of an accepted standard is needed. One must remember that the establishment of different standards hinders progress in clinical practice and research on DIC by causing division, rather than a unified approach and it is just like yielding the condition after the collapse of the Tower of Babel.…”

Section: International and Japanese Diagnostic Criteriamentioning

confidence: 99%

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

Iba

Umemura

Watanabe

et al. 2019

Acute Medicine & Surgery

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Disseminated intravascular coagulation (DIC) is a frequent complication in sepsis. Once patients develop DIC, the mortality rate increases significantly. Moreover, recent studies have suggested that coagulation disorder plays a significant role in the development of organ dysfunction in sepsis. Thus, the early detection of DIC is vital in sepsis care, and the Japanese Association for Acute Medicine established a set of original diagnostic criteria in 2006 (JAAM DIC). Since then, the usefulness of the JAAM DIC has been repeatedly reported, and these criteria have been widely adopted in emergency and critical care settings in Japan. Different criteria have also been released by the International Society on Thrombosis and Haemostasis (ISTH overt‐DIC), and the latter criteria are presently considered to be the international standard. Compared with the JAAM DIC, the ISTH overt‐DIC criteria are stricter and the timing of diagnosis is later. This discrepancy is because of conceptual differences. As many physicians think sepsis‐associated DIC is the target of anticoagulant therapies in Japan, the JAAM DIC criteria were designed to allow the early initiation of treatment. As other countries do not provide DIC‐specific treatments, early diagnosis is not necessary, and this situation has led to a significant gap. However, as overt‐DIC is a late‐phase coagulation disorder, a need for early detection has been advocated, and members of the ISTH have recently proposed the category of sepsis‐induced coagulopathy. In this review, we introduce the strengths and weaknesses of the major criteria including JAAM‐DIC, ISTH overt‐DIC, sepsis‐induced coagulopathy, and Japanese Society on Thrombosis and Haemostasis‐DIC.

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“…However, much controversy exists regarding the use of the various scoring systems in clinical applications or in DIC research. In 2015, Chinese authorities published the Chinese DIC scoring system (CDSS) [8]. This system includes 2 parts, one is for nonhematologic malignancies and the other is for hematological malignancies (Table 1).…”

Section: Introductionmentioning

confidence: 99%

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

Wei

Niu²,

Wang³

et al. 2017

Acta Haematol

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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.

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Retrospective Evaluation of New Chinese Diagnostic Scoring System for Disseminated Intravascular Coagulation

Cited by 18 publications

References 21 publications

Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy

Improving the safety of CAR-T cell therapy by controlling CRS-related coagulopathy

Diagnosis of sepsis‐induced disseminated intravascular coagulation and coagulopathy

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

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