Feasibility of Applying Novel FDP Threshold Criteria to DIC Diagnostic Scoring Systems in Japanese Women with Placental Abruption

Abstract

<i>Objectiv</i>e: The diagnosis of disseminated intravascular coagulation (DIC) in obstetrics characterized by marked elevation of fibrin/fibrinogen degradation products (FDP) requires specific FDP criteria, however, no reference values are currently available. We previously reported the FDP criteria reflecting the degree of coagulation activity, determined by the quantitative relation between the distributions of FDP and fibrinogen. We aimed to evaluate the feasibility of applying the novel FDP criteria to four existing DIC diagnostic scoring systems, in a retrospective study of Japanese women with placental abruption. <i>Materials and Methods</i>: The study population was 68 pregnant women who had been diagnosed with placental abruption at Okayama Medical Center (Japan) between January 2008 and December 2020. DIC was clinically determined using the following four categories: plasma fibrinogen level < 100 mg/dl, hemorrhage amount at delivery ≥ 2000 g, blood product (red blood cells and fresh frozen plasma) transfusion, and renal dysfunction. Based on our previous report on the artificial intelligence analysis of the FDP distribution function, FDP criteria for the normal upper limit, moderate increase, and marked increase were defined as 20, 32, and 80 μg/ml, respectively. We applied the FDP criteria to compare four current and revised DIC diagnostic scoring systems: Japanese Ministry of Health and Welfare (JMHW), Japanese Association for Acute Medicine (JAAM), International Society on Thrombosis and Haemostasis (ISTH), and pregnancy-modified ISTH (PM-ISTH) DIC score. We used the Kruskal-Wallis test, Wilcoxon rank-sum test, and proportion test for statistical analysis. <i>Results</i>: Clinical DIC was observed in nine cases. Sensitivity was 1.00 in all DIC scoring systems. The current/revised sensitivity of the JMHW, JAAM, ISTH, and PM-ISTH systems was 1.00/1.00, 1.00/1.00, not available (NA)/1.00, and 1.00/NA, respectively. The current/revised specificity of the JMHW, JAAM, ISTH, and PM-ISTH systems was 0.864/0.864, 0.678/0.797, NA/0.864, and 0.424/NA, respectively. The specificity of the revised JMHW and revised ISTH systems was higher than for the current JAAM (<I>P </I>< 0.05) and current PM-ISTH (<I>P </I>< 0.0001) systems. The specificity of the revised JAAM improved from 0.678 to 0.797. <i>Conclusion</i>: Our novel proposed FDP criteria are potentially useful for diagnosis of DIC in placental abruption.