A Multicenter, Prospective Validation of Disseminated Intravascular Coagulation Diagnostic Criteria for Critically Ill Patients: Comparing Current Criteria

Abstract number: P1399

Satoshi G, Shigeatsu E

Objectives:  To validate scoring algorithm of Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria and to evaluate its diagnostic property by comparing the two leading scoring systems for DIC, the Japanese Ministry Health and Welfare (JMHW) and International Society on Thrombosis and Haemostasis (ISTH).

Design:  Prospective, multicenter study during a 3 months period.

Patients:  Two hundred and seventy three patients with platelet counts less than 150 × 10⁹/L were enrolled.

Measurements and main results:  The JAAM, JMHW, and ISTH DIC scoring algorithms were prospectively applied within 12 hours patients met the inclusion criteria (day 0) to days 1–3 by measuring global coagulation tests. The numbers of systemic inflammatory response syndrome (SIRS) criteria and Sequential Organ Failure Assessment (SOFA) score were determined simultaneously. Mortality from any cause was also assessed 28 days after the enrollment. All global coagulation tests and SIRS criteria adopted in the JAAM criteria and their cutoff points were validated using SOFA scores and mortality rate. The JAAM DIC scoring system was significantly superior to the other criteria in DIC diagnostic rate and death prediction rate and could find a lot of DIC patients at the earliest days after enrollment. Patients fulfilled the JAAM DIC included almost all patients diagnosed by the JMHW and ISTH scoring systems. The JAAM DIC scores showed significant correlation with SOFA scores. SOFA score and mortality rate worsened in accordance with an increase in the JAAM DIC score. Logistic regression analysis demonstrated that fibrinogen criteria had little effect predicting outcome of the DIC patients and total score 4 points in the JAAM scoring system without fibrinogen closely related to poor prognosis. According to the results we revised the JAAM criteria. Receiver operating curve (ROC) analysis for outcome by three DIC diagnostic criteria showed better tendency of the area under ROC curve by the revised JAAM criteria than the JMHW and ISTH criteria.

Conclusions:  The JAAM scoring system has an acceptable property for the diagnosis of DIC. The JAAM DIC showed hierarchical continuum to the JMHW and ISTH DIC. Revised JAAM DIC criteria preserved all properties for DIC diagnosis of the original criteria. The revised scoring system can be useful in a critical care setting.