Abstract
Background. The diagnostic criteria for disseminated intravascular coagulation (DIC) vary and are complicated and the cut-off values are different. Simple and quick diagnostic criteria for DIC are required in physicians for critical care. Material and methods. Platelet counts, prothrombin time–international normalized ratio (PT-INR) and D-dimer levels were examined in 1293 critical ill patients. Adequate cut-off values of these parameters were determined and a quick DIC score using these biomarkers was proposed. The quick DIC score was evaluated using a receiver operating characteristic (ROC) analysis. Results. Using the Japanese Ministry of Health, Labor and Welfare diagnostic criteria, 70 and 109 patients were diagnosed with DIC and pre-DIC, respectively. The ROC analysis of factors difference between DIC and non-DIC, revealed the following cut-off values: PT-INR, 1.20; platelet count, 12.0 × 1010/L and D-dimer, 10.0 μg/mL. Based on the above results, the quick DIC score system was proposed. All patients with DIC had a quick DIC score of 3, 4 or 5, and 85.3% of the patients with pre-DIC had a quick DIC score of ≥3 points. All patients with pre-DIC had a score of ≥2 points. In the ROC analysis, the area under the curve was 0.997 for DIC vs. non-DIC, and 0.984 for pre-DIC + DIC vs. non-DIC, and the cut-off value was 3 points for DIC and 2 points for DIC + pre-DIC. The quick DIC scores of non-survivors were significantly higher than those of survivors. Conclusions. The Quick DIC score system is a simple and useful tool that can be used for the diagnosis of DIC and pre-DIC. Further evaluation of the quick DIC score system in a large-scale study is required.
Highlights
Disseminated intravascular coagulation (DIC) is frequently associated with infectious diseases, hematological malignancy, and solid cancer, and causes organ failure and bleeding symptoms, often resulting in poor outcomes [1,2]
Diagnostic criteria for disseminated intravascular coagulation (DIC) have been established by the Japanese Ministry of Health, Labor and Welfare (JMHLW) [7], the International Society of Thrombosis Haemostasis (ISTH) [8], the Japanese Association for Acute Medicine (JAAM) [9], and the Japanese Society of Thrombosis Hemostasis (JSTH) [10]
Regarding the evaluation of patients using the JMHLW diagnostic criteria, 70 and 109 patients were diagnosed with DIC and pre-DIC, respectively
Summary
Disseminated intravascular coagulation (DIC) is frequently associated with infectious diseases, hematological malignancy, and solid cancer, and causes organ failure and bleeding symptoms, often resulting in poor outcomes [1,2]. Diagnostic criteria for DIC have been established by the Japanese Ministry of Health, Labor and Welfare (JMHLW) [7], the International Society of Thrombosis Haemostasis (ISTH) [8], the Japanese Association for Acute Medicine (JAAM) [9], and the Japanese Society of Thrombosis Hemostasis (JSTH) [10]. These diagnostic criteria for DIC are based on scoring systems that include the platelet counts, prothrombin time (PT), fibrin-related markers, and fibrinogen [11]. The diagnostic criteria for disseminated intravascular coagulation (DIC) vary and are complicated and the cut-off values are different. Further evaluation of the quick DIC score system in a large-scale study is required
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