Utility of the Fibrinogen/C-Reactive Protein Ratio for the Diagnosis of Disseminated Intravascular Coagulation

Abstract

Although the presence of decreased plasma fibrinogen has been regarded as an indicator of ongoing disseminated intravascular coagulation (DIC), fibrinogen, which is one of the acute phase reactants, is often increased in the patients with DIC. We investigated the diagnostic and prognostic utility of a new parameter [the fibrinogen/C-reactive protein (CRP) ratio] for predicting DIC in 1,056 patients with suspected DIC and who also had underlying disorders associated with DIC. Among the 535 patients with overt DIC, 46 patients (8.6%) showed low plasma fibrinogen (<100 mg/dl), suggesting that the plasma fibrinogen level is not a sensitive marker for DIC. There was a strong correlation between the increased DIC scores and increased number of patients with low (<104) fibrinogen/CRP ratios. Among the three groups with different serum fibrinogen/fibrin degradation product levels, the fibrinogen/CRP ratio showed a higher difference than did the fibrinogen level. The DIC score was highly correlated with the 28-day mortality and the number of patients with low fibrinogen/CRP ratios. The odds ratio (the relative risk of 28-day mortality) of the low fibrinogen/CRP ratio was 6.15, while the odds ratio of the low fibrinogen level was 2.13. The area under the receiver-operating characteristic curve of the fibrinogen/CRP ratio, when this was used for predicting mortality, showed significantly better discriminative power than did that of the fibrinogen level. This study demonstrates that the fibrinogen/CRP ratio may provide more discriminating power for identifying the patients with active coagulation consumption, and the fibrinogen/CRP ratio has a good predictive value concerning the 28-day mortality in the patients suspected of having DIC. The results of our study suggest that replacement of fibrinogen by the fibrinogen/CRP ratio for calculating the DIC score may lead to enhance diagnostic and prognostic power for DIC.

Coagulation Proteins Influencing Global Coagulation Assays in Cirrhosis: Hypercoagulability in Cirrhosis Assessed by Thrombomodulin-Induced Thrombin Generation Assay

“…However, our results show that fibrinogen level paradoxically affect the prolongation of lag time. Since fibrinogen is a well-known acute phase protein [10], this fibrinogen level may be increased in inflammatory status of cirrhotic patients. After all, the increased fibrinogen levels are accompanied by the reduced levels of other coagulation factors in cirrhotic patients.…”

Evidence of Disseminated Intravascular Coagulation in a Hemorrhagic Fever with Renal Syndrome—Scoring Models and Severe Illness

“…The ISTH DIC-scoring has earlier been found useful in identifying patients with suspected DIC [37], and especially in ICU patients [40], [49], [50]. Sepsis has been proposed to be the most frequent cause of DIC with a high mortality [51].…”

“…The original ISTH overt DIC-scoring template allows a choice of two different models based on D-dimer cut-offs [42]. Correction for fibrinogen/CRP-ratio has been suggested and was included [37]. This gave us four different overt DIC templates (DIC 1–4, Table 1).…”

“…In this table laboratory cutoffs are set from local decision limits and also corrected with a fibrinogen/CRP ratio [37]. Overt DIC-score ≥5p: compatible with overt DIC, <5p: suggestive for non-overt DIC.…”

“…non- overt DIC , with haemostatic dysfunction but still a compensated coagulation system, and overt DIC , with a decompensated coagulation system. Earlier studies have shown the overt DIC template to have high sensitivity and specificity for DIC [36], and also that replacing fibrinogen with a fibrinogen/CRP-ratio further enhanced the diagnostic and prognostic power of the template [37]. Recently, Laine et al showed that 5 out of 19 patients with NE fulfilled the criteria for DIC according to ISTH [38].…”