Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Hemostasis (ISTH) and of the Japanese Ministry of Health and Welfare for overt DIC

We compared the criteria set by the International Society of Thrombosis and Hemostasis (ISTH) for the diagnosis of disseminated intravascular coagulation (DIC) with the criteria of the Japanese Ministry of Health and Welfare (JMHW) set for the diagnosis of overt DIC. We studied 1,284 Japanese patients with DIC. The rate of agreement in the diagnosis of DIC by the two diagnostic systems was 67.4%. In addition, only 2.0% of non‐DIC patients by JMHW criteria were diagnosed with overt DIC by ISTH criteria, suggesting that ISTH for overt DIC includes typical cases of DIC. The concordance of diagnosis for DIC by ISTH and JMHW was significantly high in patients with trauma or acute promyelocytic leukemia. About 70% of DIC or overt DIC patients had more than 1 point in the scoring system for prothrombin time, but >50% of those patients had 0 point for plasma fibrinogen level. Abnormal fibrin and fibrinogen degradation product (FDP) levels and platelet counts were observed in >88% of DIC and overt DIC patients but were observed in >50% of non‐DIC patients, indicating that these parameters are sensitive markers but not specific markers for the diagnosis of DIC. Considered together, our results suggest that the diagnostic criteria for DIC and overt DIC could be improved by changing the cut‐off values of the global coagulation tests. Am. J. Hematol. 74:17–22, 2003. © 2003 Wiley‐Liss, Inc.

[1]  A. Quick,et al.  A STUDY OF THE COAGULATION DEFECT IN HEMOPHILIA AND IN JAUNDICE. , 1935 .

[2]  R. Rosenthal.  Acute promyelocytic leukemia associated with hypofibrinogenemia. , 1963 .

[3]  H. Gralnick,et al.  Heparin treatment for the hemorrhagic diathesis of acute promyelocytic leukemia. , 1972, The American journal of medicine.

[4]  T. Poll,et al.  Disseminated intravascular coagulation. , 1977 .

[5]  D. Rylatt,et al.  An immunoassay for human D dimer using monoclonal antibodies. , 1983, Thrombosis research.

[6]  T Maekawa,et al.  Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. , 1983, Bibliotheca haematologica.

[7]  J. Mimuro,et al.  Monoclonal antibodies to discrete regions in alpha 2-plasmin inhibitor. , 1987, Blood.

[8]  H. Pelzer,et al.  Determination of Human Thrombin-Antithrombin III Complex in Plasma with an Enzyme-Linked Immunosorbent Assay , 1988, Thrombosis and Haemostasis.

[9]  Tatsuya Hayashi,et al.  Plasma thrombomodulin as a marker of vascular disorders in thrombotic thrombocytopenic purpura and disseminated intravascular coagulation , 1992, American journal of hematology.

[10]  Koji Suzuki,et al.  Hemostatic study before onset of disseminated intravascular coagulation , 1993, American journal of hematology.

[11]  F. Cerra,et al.  Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. , 1994, JAMA.

[12]  J. Nishioka,et al.  Increased activated protein C-protein C inhibitor complex levels in patients with pulmonary embolism. , 1994, Thrombosis and haemostasis.

[13]  H. Shiku,et al.  Outcome of Disseminated Intravascular Coagulation in Relation to the Score when Treatment was Begun , 1995, Thrombosis and Haemostasis.

[14]  H. Shiku,et al.  Increased plasma‐soluble fibrin monomer levels in patients with disseminated intravascular coagulation , 1996, American journal of hematology.

[15]  S. Schulman.  Optimal Duration of Oral Anticoagulant Therapy in Venous Thromboembolism , 1997, Thrombosis and Haemostasis.

[16]  C. Waydhas,et al.  High-dose antithrombin III treatment of severely injured patients: results of a prospective study. , 1997, The Journal of trauma.

[17]  I. Maruyama.  Recombinant Thrombomodulin and Activated Protein C in the Treatment of Disseminated Intravascular Coagulation , 1999, Thrombosis and Haemostasis.

[18]  M. Levi,et al.  The Pathophysiology of Disseminated Intravascular Coagulation , 1999, Thrombosis and Haemostasis.

[19]  M. Levi,et al.  Disseminated Intravascular Coagulation: Clinical Spectrum and Established as well as New Diagnostic Approaches , 1999, Thrombosis and Haemostasis.

[20]  E. Abraham.  Tissue factor inhibition and clinical trial results of tissue factor pathway inhibitor in sepsis. , 2000, Critical care medicine.

[21]  Mujun Yu,et al.  Screening tests of disseminated intravascular coagulation: Guidelines for rapid and specific laboratory diagnosis , 2000, Critical care medicine.

[22]  J. Spivak,et al.  Commentary on and reprint of Quick AJ, Stanley-Brown M, Bancroft FW, A study of the coagulation defect in hemophilia and in jaundice, in American Journal of the Medical Sciences (1935) 190:501–511 , 2000 .

[23]  Gary Garber,et al.  The efficacy and safety of recombinant human activated protein C for the treatment of patients with severe sepsis (vol 28, pg 48, 2000) , 2001 .

[24]  F B Taylor,et al.  Towards Definition, Clinical and Laboratory Criteria, and a Scoring System for Disseminated Intravascular Coagulation , 2001, Thrombosis and Haemostasis.

[25]  J Ean,et al.  Efficacy and safety of recombinant human activated protein C for severe sepsis. , 2001, The New England journal of medicine.

[26]  C. Esmon.  Role of Coagulation Inhibitors in Inflammation , 2001, Thrombosis and Haemostasis.

[27]  J. Vincent,et al.  The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure , 1996, Intensive Care Medicine.