Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: A multicenter prospective study

Yingying Wu,Jianming Feng,Xiaohui Zhang,Linhua Yang,Yue Han,Tienan Zhu,Jian Gu,Zeping Zhou,Yong Feng ,Feng Xue,Xiaomin Wang,Yuhong Zhou,Lili Luo,Heng Mei,Ming Hou,Yan Li,Lei Su,Qiulan Ding,Ting Niu,Jun Deng,Jun Peng,Ruibin Huang,Yu Hu

doi:10.1038/s41598-017-09190-5

Abstract

Disseminated intravascular coagulation (DIC) is a common life-threatening complication in critically ill patients. The diagnostic scoring systems of DIC enable a more prompt and accurate diagnosis of DIC, such as the International Society on Thrombosis and Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry of Health and Welfare (JMHW). This study prospectively evaluated the newly proposed Chinese DIC Scoring System (CDSS), which was conducted at 18 centers in China during a one-year period. Receiver operating characteristic (ROC) curves showed that, for diagnosis of DIC and for prediction of the 28-day all-cause mortality, the CDSS had larger areas under the ROC curve (AUCs) than the ISTH and the JAAM in different groups. The CDSS also had larger AUC than the JMHW for the ISTH DIC in non-infectious diseases. All of the AUCs of the CDSS were greater than 0.8, accompanied with both high sensitivity and high specificity. Furthermore, the CDSS score was an independent predictor of mortality (odds ratio, 1.882; p < 0.001), and could reflect the illness severity (p < 0.001 for Spearman’s rank correlations with the scores of severity). In conclusion, the CDSS is worthy of promotion with a better diagnostic and prognostic value for DIC.

Highlights

Disseminated intravascular coagulation (DIC) is a frequent and serious complication in critically ill patients with a high mortality
Several scoring systems of DIC have been proposed, such as the Japanese Ministry of Health and Welfare (JMHW) DIC criteria[5], the International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria[3], and the Japanese Association for Acute Medicine (JAAM) DIC criteria[6, 7], which are most commonly used in the world
All of them are demonstrated to be useful for the diagnosis of DIC, controversy still exists in the diagnostic performance and applicability of these criteria in different clinical settings[7,8,9,10,11,12,13,14,15], making it confusing for clinicians to select an optimal scoring system in clinical practice

Summary

Introduction

Disseminated intravascular coagulation (DIC) is a frequent and serious complication in critically ill patients with a high mortality. The latest version was established in 2012 by the Consensus of Chinese Experts on Diagnosis and Treatment of DIC4 According to this consensus, a diagnosis of DIC is established when the patient has underlying diseases which may cause DIC, accompanied with clinical manifestations and (or) abnormal laboratory findings (Supplemental Table 1). For the sake of establishing a diagnostic scoring system for DIC which has both high sensitivity and high specificity in different clinical settings, and is suited to the current clinical practice of China and even worth of promotion throughout the world, the Chinese DIC Scoring System (CDSS) was proposed in 2014.

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