Elsevier

Critical Care Clinics

Volume 28, Issue 3, July 2012, Pages 373-388
Critical Care Clinics

The Utility of a Diagnostic Scoring System for Disseminated Intravascular Coagulation

https://doi.org/10.1016/j.ccc.2012.04.004Get rights and content

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The Need for a Treatment for DIC

Although most clinicians are aware of the general conditions resulting from DIC, a precise description of the syndrome and a good working definition and useful scoring system were not available until recently. Therefore, in spite of the fact that DIC was sometimes referred to as “Death Is Coming” by hematologists, most critical care physicians considered that DIC was merely the endpoint of organ dysfunction and it was ignored as an epiphenomenon associated with various serious illnesses in the

Laboratory Tests for the DIC Diagnostic Scoring System

There has been no single test that is sufficiently accurate to establish or rule out a diagnosis of DIC. Therefore, the diagnostic scoring system for DIC uses a combination of several laboratory tests.33, 34 Because DIC is a dynamic process that varies with time, the disease parameters should always be repeatedly evaluated based on the sequential monitoring of readily available and inexpensive laboratory tests that can be measured in laboratories worldwide.

The Diagnostic Scoring System for DIC

Scoring systems for DIC, developed from the JMHW scoring system, have been independently proposed by the ISTH and the JAAM.3, 4, 5, 10 The most striking difference in the latter two systems from the JMHW scoring system is a deletion of the points for underlying disorders, bleeding symptoms, and thrombosis-related organ dysfunction. Instead of adding one point for underlying disorders, the ISTH criterion added a table of “clinical conditions that may be associated with DIC” as a mandatory

Overt DIC

Table 1 shows the ISTH overt DIC scoring system.5 The diagnostic accuracy of the ISTH score was evaluated in 217 consecutive patients suspected to have DIC who were admitted to the intensive care unit (ICU).12 The study showed an acceptable accuracy for the diagnosis of DIC in critically ill patients with sepsis, severe sepsis, surgery, trauma, and so forth. The severity of DIC according to this scoring system is related to the mortality of patients with sepsis and other critical conditions.28,

The JAAM DIC Diagnostic Scoring System

Table 2 shows the JAAM DIC diagnostic scoring system.10, 11 The JAAM developed and published the JAAM DIC scoring system especially for critically ill patients based on problems discovered with the old JMHW scoring system, such as the low sensitivity for diagnosis and the lack of objective tools for scoring points associated with bleeding symptoms and thrombosis-related organ dysfunction.10 Two prospective studies validated its clinical significance for the early and definite diagnosis of DIC

The JMHW DIC Diagnostic Scoring System

The JMHW DIC scoring system was first published two decades ago and has been widely used in both research and clinical investigations. However, its diagnostic accuracy has not been assessed until recently.69 The JMHW DIC scoring system showed moderate sensitivity and high specificity for the diagnosis of DIC patients with hematologic malignancies; however, its usefulness for critically ill patients has not been validated. The diagnostic algorithm of the JMHW scoring system can be found

Summary

DIC is an acquired syndrome characterized by microvascular thrombosis as a result of the activation of coagulation, and it can produce organ dysfunction, leading to a poor prognosis for critically ill patients. Therefore, DIC should be recognized as a serious condition that should be diagnosed and treated as early as possible in the critical care setting. Prospectively validated DIC scoring systems with various diagnostic properties are now available for the DIC diagnosis. The selection of the

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