A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria.
OBJECTIVE
To validate scoring algorithm criteria established by the Japanese Association for Acute Medicine (JAAM) for disseminated intravascular coagulation (DIC) and to evaluate its diagnostic property by comparing the two leading scoring systems for DIC, from the Japanese Ministry of Health and Welfare (JMHW) and International Society on Thrombosis and Haemostasis (ISTH).


METHODS
Prospective, multicenter study during a 3-month period.


METHODS
General critical care center in a tertiary care hospital.


METHODS
Two hundred seventy-three patients with platelet counts<150x109/L were enrolled.


METHODS
None.


RESULTS
The JAAM, JMHW, and ISTH DIC scoring algorithms were prospectively applied within 12 hrs of patients meeting the inclusion criteria (day 0) to days 1-3, by global coagulation tests. The numbers of systemic inflammatory response syndrome (SIRS) criteria and Sequential Organ Failure Assessment (SOFA) scores were determined simultaneously. Mortality associated with 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 with use of SOFA scores and mortality rate. DIC diagnostic rate of the JAAM DIC scoring system was significantly higher than that of the other two criteria (p<.001). The JAAM DIC algorithm was the most sensitive for early diagnosis of DIC (p<.001). PATIENTS who fulfilled the JAAM DIC criteria included almost all those whose DIC was diagnosed by the JMHW and ISTH scoring systems. The JAAM DIC scores showed significant correlation with SOFA scores ([rho]=0.499; p<.001). SOFA score and mortality rate worsened in accordance with an increase in the JAAM DIC score. Fibrinogen criteria had little effect in predicting outcome for the DIC patients, and a total score of 4 points in the JAAM scoring system without fibrinogen was closely related to poor prognosis. According to the results, we revised the JAAM criteria by excluding fibrinogen and confirmed that the DIC diagnostic properties of original criteria remained unchanged in the revised JAAM criteria.


CONCLUSIONS
The JAAM scoring system has an acceptable property for the diagnosis of DIC. The scoring system identified most of the patients diagnosed by the JMHW and ISTH criteria. Revised JAAM DIC criteria preserved all properties of the original criteria for DIC diagnosis. The revised scoring system can be useful for selecting DIC patients for early treatment in a critical care setting.
Gando
Satoshi
S
Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan. gando@med.hokudai.ac.jp
Iba
Toshiaki
T
Eguchi
Yutaka
Y
Ohtomo
Yasuhiro
Y
Okamoto
Kohji
K
Koseki
Kazuhide
K
Mayumi
Toshihiko
T
Murata
Atsuo
A
Ikeda
Toshiaki
T
Ishikura
Hiroyasu
H
Ueyama
Masashi
M
Ogura
Hiroshi
H
Kushimoto
Shigeki
S
Saitoh
Daizoh
D
Endo
Shigeatsu
S
Shimazaki
Shuji
S
D000465:Algorithms; D016638:Critical Illness; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000503:physiopathology