Factor VIII levels and ISTH DIC scores do not distinguish DIC from the coagulopathy of liver disease.

Abstract

Distinguishing DIC from the coagulaopathy of liver disease represents a common clinical challenge. Here, we evaluated the clinical utility of two diagnostic tools frequently used to differentiate between these conditions: factor VIII (FVIII) levels and the ISTH DIC score. To this end, we conducted a retrospective chart review of patients with DIC, liver disease, or both. Multiple logistic regression was performed and receiver operating characteristic curves were generated to calculate area under the curve (AUC) for distinguishing DIC in the setting of liver disease. Amongst 123 patients with DIC, liver disease, or liver disease plus DIC, FVIII levels did not differ significantly. ISTH scores were lower in patients with DIC than in liver disease with or without DIC. Addition of several laboratory parameters, including MPV, FV, FVIII, INR, and PTT, to the ISTH DIC score improved AUC for distinguishing DIC in liver disease from liver disease alone (AUC = 0.76; P < 0.0001). We conclude that FVIII levels do not distinguish DIC from liver disease, and ISTH DIC scores are not predictive of DIC in patients with liver disease. Inclusion of additional lab variables within the ISTH DIC score may aid in identifying DIC in patients with liver disease.