title: International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients.
abstract: We evaluated the score for disseminated intravascular coagulation (DIC) recently published by the International Society for Thrombosis and Haemostasis (ISTH) in a well-defined series of sepsis patients. Thirty-two patients suffering from severe sepsis and eight patients with septic shock were evaluated following the ISTH DIC score. Fibrin monomer and D-dimer were chosen as fibrin-related markers (FRM), respectively. DIC scores for nonsurvivors (n = 13) as well as for septic shock patients were higher (P < 0.04) compared with survivors and patients with severe sepsis, respectively. Using fibrin monomer and D-dimer, 30 and 25% of patients suffered from overt DIC. Overt DIC was associated with significantly elevated thrombin-antithrombin complexes and plasminogen activator inhibitor type-1 levels as well as with significantly lower factor VII clotting activity. Patients with overt DIC had a significantly higher risk of death and of developing septic shock. Since more than 95% of the sepsis patients had elevated FRM, the DIC score was strongly dependent on prolongation of the prothrombin time and platelet counts. The ISTH DIC score is useful to identify patients with coagulation activation, predicting fatality and disease severity. It mainly depends on the prolongation of the prothrombin time and platelet counts.
authors.affiliation: Divison of Hematology and Central Hematology Laboratory, Kantonsspital Lucerne, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Voves
authors.forename: Walter A
authors.initials: WA
authors.lastname: Wuillemin
authors.forename: Sacha
authors.initials: S
authors.lastname: Zeerleder
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000097:blood; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000150:complications / Q000401:mortality; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000737:chemistry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000150:complications / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000150:complications / Q000401:mortality; D012955:Societies, Medical / Q000592:standards; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; C011468:fibrinmonomer