J Korean Med Sci.  2016 Nov;31(11):1838-1845. 10.3346/jkms.2016.31.11.1838.

Performance Evaluation of Five Different Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Predicting Mortality in Patients with Complicated Sepsis

• Ha SO
• Park SH
• Hong SB
• Jang S

• KMID: 2470283
• DOI: http://doi.org/10.3346/jkms.2016.31.11.1838

Abstract

Disseminated intravascular coagulation (DIC) is a major complication in sepsis patients. We compared the performance of five DIC diagnostic criteria, focusing on the prediction of mortality. One hundred patients with severe sepsis or septic shock admitted to intensive care unit (ICU) were enrolled. Routine DIC laboratory tests were performed over the first 4 days after admission. The overall ICU and 28-day mortality in DIC patients diagnosed from five criteria (International Society on Thrombosis and Haemostasis [ISTH], the Japanese Association for Acute Medicine [JAAM], the revised JAAM [R-JAAM], the Japanese Ministry of Health and Welfare [JMHW] and the Korean Society on Thrombosis and Hemostasis [KSTH]) were compared. Both KSTH and JMHW criteria showed superior performance than ISTH, JAAM and R-JAAM criteria in the prediction of overall ICU mortality in DIC patients (odds ratio 3.828 and 5.181, P = 0.018 and 0.006, 95% confidence interval 1.256-11.667 and 1.622-16.554, respectively) when applied at day 1 after admission, and survival analysis demonstrated significant prognostic impact of KSTH and JMHW criteria on the prediction of 28-day mortality (P = 0.007 and 0.049, respectively) when applied at day 1 after admission. In conclusion, both KSTH and JMHW criteria would be more useful than other three criteria in predicting prognosis in DIC patients with severe sepsis or septic shock.

Keyword

Criteria; Diagnosis; Disseminated Intravascular Coagulation; Mortality; Sepsis

MeSH Terms

Aged
Area Under Curve
Blood Platelets/cytology
Disseminated Intravascular Coagulation/complications/*diagnosis
Female
Fibrinogen/analysis
Humans
Intensive Care Units
Logistic Models
Male
Middle Aged
Odds Ratio
Partial Thromboplastin Time
Platelet Count
Prospective Studies
Prothrombin Time
ROC Curve
Sepsis/*complications/mortality
Severity of Illness Index
Survival Analysis
Systemic Inflammatory Response Syndrome/complications
Fibrinogen

Figure

• 

  Fig. 1 Comparison of five different DIC diagnostic criteria in terms of predicting 28-day mortality when applied at Day 1. Kaplan-Meier survival curve analysis shows that the KSTH (A) and JMHW (E) criteria could significantly predict 28-day mortality when applied at Day 1. However, ISTH (B), JAAM (C) and R-JAAM (D) criteria could not significantly predict 28-day mortality when applied at Day 1. ISTH = International Society on Thrombosis and Haemostasis, JAAM = Japanese Association for Acute Medicine, JMHW = Japanese Ministry of Health and Welfare, KSTH = Korean Society on Thrombosis and Hemostasis, R-JAAM = revised JAAM.

Reference

1. Levi M, de Jonge E, van der Poll T. Sepsis and disseminated intravascular coagulation. J Thromb Thrombolysis. 2003; 16:43–47.

2. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999; 341:586–592.

3. Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009; 145:24–33.

4. Di Nisio M, Baudo F, Cosmi B, D’Angelo A, De Gasperi A, Malato A, Schiavoni M, Squizzato A; Italian Society for Thrombosis and Haemostasis. Diagnosis and treatment of disseminated intravascular coagulation: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res. 2012; 129:e177–84.

5. Lee JH, Song JW, Song KS. Diagnosis of overt disseminated intravascular coagulation: a comparative study using criteria from the International Society versus the Korean Society on Thrombosis and Hemostasis. Yonsei Med J. 2007; 48:595–600.

6. Gando S, Wada H, Asakura H, Iba T, Eguchi Y, Okamoto K, Ohtomo Y, Kawasugi K, Koga S, Koseki K, et al. Evaluation of new Japanese diagnostic criteria for disseminated intravascular coagulation in critically ill patients. Clin Appl Thromb Hemost. 2005; 11:71–76.

7. Gando S, Iba T, Eguchi Y, Ohtomo Y, Okamoto K, Koseki K, Mayumi T, Murata A, Ikeda T, Ishikura H, et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. 2006; 34:625–631.

8. Gando S, Saitoh D, Ogura H, Mayumi T, Koseki K, Ikeda T, Ishikura H, Iba T, Ueyama M, Eguchi Y, et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med. 2008; 36:145–150.

9. Iwai K, Uchino S, Endo A, Saito K, Kase Y, Takinami M. Prospective external validation of the new scoring system for disseminated intravascular coagulation by Japanese Association for Acute Medicine (JAAM). Thromb Res. 2010; 126:217–221.

10. Angstwurm MW, Dempfle CE, Spannagl M. New disseminated intravascular coagulation score: a useful tool to predict mortality in comparison with acute physiology and chronic health evaluation II and logistic organ dysfunction scores. Crit Care Med. 2006; 34:314–320.

11. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101:1644–1655.

12. Wada H, Wakita Y, Nakase T, Shimura M, Hiyoyama K, Nagaya S, Mori Y, Shiku H. Outcome of disseminated intravascular coagulation in relation to the score when treatment was begun. Mie DIC Study Group. Thromb Haemost. 1995; 74:848–852.

13. Wada H, Asakura H, Okamoto K, Iba T, Uchiyama T, Kawasugi K, Koga S, Mayumi T, Koike K, Gando S, et al. Expert consensus for the treatment of disseminated intravascular coagulation in Japan. Thromb Res. 2010; 125:6–11.

14. Wada H, Gabazza EC, Asakura H, Koike K, Okamoto K, Maruyama I, Shiku H, Nobori T. Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Hemostasis and of the Japanese Ministry of Health and Welfare for overt DIC. Am J Hematol. 2003; 74:17–22.

15. Hayakawa M, Gando S, Hoshino H. A prospective comparative study of three sets of criteria for disseminated intravascular coagulation: ISTH criteria vs Japanese criteria. Clin Appl Thromb Hemost. 2007; 13:65–72.

16. Gando S, Saitoh D, Ogura H, Fujishima S, Mayumi T, Araki T, Ikeda H, Kotani J, Kushimoto S, Miki Y, et al. A multicenter, prospective validation study of the Japanese Association for Acute Medicine disseminated intravascular coagulation scoring system in patients with severe sepsis. Crit Care. 2013; 17:R111.

17. Takemitsu T, Wada H, Hatada T, Ohmori Y, Ishikura K, Takeda T, Sugiyama T, Yamada N, Maruyama K, Katayama N, et al. Prospective evaluation of three different diagnostic criteria for disseminated intravascular coagulation. Thromb Haemost. 2011; 105:40–44.

18. Bakhtiari K, Meijers JC, de Jonge E, Levi M. Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation. Crit Care Med. 2004; 32:2416–2421.

19. Kim GY, Park SY, Yoon HJ, Suh JT, Kang SY, Lee WI. Investigation of hemostatic changes in patients with sepsis. Korean J Lab Med. 2007; 27:157–161.

20. Kinasewitz GT, Yan SB, Basson B, Comp P, Russell JA, Cariou A, Um SL, Utterback B, Laterre PF, Dhainaut JF; PROWESS Sepsis Study Group. Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism. [ISRCTN74215569]. Crit Care. 2004; 8:R82–90.