Diagnosis of non-overt disseminated intravascular coagulation made according to the International Society on Thrombosis and Hemostasis criteria with some modifications

BACKGROUND: An early diagnosis of disseminated intravascular coagulation (DIC) before its progression to an overt stage is necessary for early treatment and positive outcomes. In 2001, the Scientific and Standardization Committee (SCC) of the International Society on Thrombosis and Hemostasis (ISTH) proposed new criteria for the preclinical diagnosis of overt and non-overt DICs. We investigated the clinical usefulness of the modified ISTH criteria for non-overt DIC diagnosis. METHODS: We enrolled 296 DIC patients (170 males and 126 females) admitted and evaluated at the Gangnam Severance Hospital, Seoul, Korea, between March 2006 and April 2007. Hemostatic tests, including platelet counts, prothrombin time (PT), D-dimer levels with antithrombin, and protein-C levels, were evaluated by excluding negative scores with clinical signs, in which more than 5 points of interest denoted non-overt DIC. Mortality rates were also evaluated. RESULTS: There were 289 patients with increased D-dimer levels and significant parametric changes suggesting DIC progression. Protein C and antithrombin levels were lower (99.2% each) and appeared earlier in patients with non-overt DIC than in patients with overt DIC. In all, 125 (43.3%) patients had non-overt DIC and, of which 27 died (mortality rate, 21.6%). The sensitivity and specificity for mortality were 73.0% and 55.9%, respectively, which were same as those for the original ISTH criteria. CONCLUSION: The modified ISTH criteria can be used for the early detection of non-overt DIC, and may be useful for the improvement of outcomes of non-overt DIC patients.

Diagnosis of Overt Disseminated Intravascular Coagulation: A Comparative Study Using Criteria from the International Society Versus the Korean Society on Thrombosis and Hemostasis

PURPOSE: Since 1993, Koreans have used diagnostic criteria set by the Korean Society on Thrombosis and Hemostasis (KSTH) in the diagnosis of overt disseminated intravascular coagulation (DIC). In 2001, the Scientific and Standardization Committee (SCC) of the International Society on Thrombosis and Hemostasis (ISTH) proposed new diagnostic criteria for the diagnosis of overt DIC. We wanted to compare the use of the ISTH versus KSTH criteria in the diagnosis of overt DIC. MATERIALS AND METHODS: We enrolled 131 patients over the age of 15 years, who had been admitted and diagnosed as having DIC from May 2000 to April 2005 at the Youngdong Severance Hospital, Seoul, Korea. Of the 131 patients, there were 71 males and 60 females, with a median age of 61 years. Hemostatic tests, including platelet counts, PT, aPTT, fibrinogen level and D-dimer, were evaluated based on the respective scoring systems. To assess the concordance between the two diagnostic systems, we used the Student's t-test and the K-coefficient. RESULTS: There were 79 patients compatible with the ISTH criteria and 63 patients with the KSTH criteria. Sixty-one patients were compatible with both diagnostic systems. The grade of agreement, or concordance rate, was 84.7% and the K-coefficient, or interrater reliability, was as low as 0.6 without significance. However, if we scored 1 point for a fibrinogen level of 100-150mg/dL, and 2 points for a level below 100mg/dL, for the ISTH criteria, then 63 patients were compatible with both diagnostic systems, and the concordance rate increased to 85.5% and the K-coefficient to 0.71 with significance. CONCLUSION: To achieve good agreement between the ISTH and KSTH diagnostic systems for overt DIC, we highly recommend changing the plasma fibrinogen cut-off value in the ISTH criteria from 100mg/dL to 150mg/dL and scoring up to 2 points for a level below 100 mg/dL.

Low-dose endotoxin induces non-overt disseminated intravascular coagulation in rabbits / 第三军医大学学报

Objective To study the changes of coagulation and fibrinolysis in rabbit model of non-overt disseminated intravascular coagulation induced by low-dose endotoxin and therapeutic effects of anticoagulation by heparin.Methods Twelve male rabbits were randomly divided into 2 groups,one receiving endotoxin intravenously(10 ?g/kg,n=6),one receiving endotoxin intravenously and 100 U/kg Heparin simultaneously(n=6).The blood sample obtained before experiment was used as control.Coagulation parameters including prothrombin time(PT),activated partial thromboplastin time(aPTT),thrombin time(TT),fibrinogen concentration,D-dimers,thrombelastography(TEG)were measured during 6 h after endotoxin induction.Tissue specimens of lungs and kidneys were examined.Results Parameters of coagulation deteriorated significantly in the endotoxin-induced rabbits,but was not altered in heparin-treated rabbits.TEG monitoring in the endotoxin-induced rabbits reflected consumption of clot factors and platelet dysfunction,and hypocoagulation status in heparin-treated rabbits.In endotoxin-induced group,fibrin deposition was found in lungs and kidneys.Conclusion Non-overt disseminated intravascular coagulation induced by low-dose endotoxin in rabbits is improved by heparin.