International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation ≥ 6: a new predictor of hemorrhagic early death in acute promyelocytic leukemia.
High-hemorrhagic early death (ED) rate is a major impediment in the managing of acute promyelocytic leukemia (APL). In our group of 56 newly diagnosed APL patients, ED occurred in 12 subjects, due to endocranial bleeding (8/12), differentiation syndrome (2/12), or infection (2/12). Predictors of hemorrhagic ED were as follows: white blood cells count ≥ 20 × 10(9)/L (P = 0.002337), Eastern cooperative oncology group performance status ≥ 3 (P = 0.00173), fibrinogen level <2 g/L (P = 0.004907), prothrombin time <50% (P = 0.0124), and International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation (ISTH DIC score) ≥ 6 (P = 0.00741). Multivariate analysis indicated ISTH DIC score ≥ 6 to be the most significant predictor for hemorrhagic ED (P = 0.008). The main finding of this study is that simple coagulation-related tests, performed on hospital admission and combined in the ISTH DIC score, might help to identify patients at high risk for fatal bleeding needing more aggressive supportive measures.
Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia. mmg@beotel.net
Mirjana
M
Mitrovic
Nada
N
Suvajdzic
Andrija
A
Bogdanovic
Nada Kraguljac
NK
Kurtovic
Aleksandra
A
Sretenovic
Ivo
I
Elezovic
Dragica
D
Tomin
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D055815:Young Adult