title: Revision of the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) diagnostic criteria using antithrombin activity.
abstract: BACKGROUND
  With advances in the treatment of sepsis, the systemic inflammatory response syndrome (SIRS) has been losing its prognostic power. Since the SIRS category is no longer used for the diagnosis of sepsis, the disseminated intravascular coagulation (DIC) diagnostic criteria released by Japanese Association for Acute Medicine (JAAM) should be modified. Thus, the purpose of this study was to examine the appropriateness of replacing the SIRS score with antithrombin activity in JAAM-DIC diagnostic criteria.
  
  
  METHODS
  We analyzed data from 819 septic patients who had received recombinant thrombomodulin. The relationships between the 28-day mortality rate and baseline laboratory and clinical parameters were examined using univariate and multivariate analyses, and the impact of replacing the SIRS criteria with antithrombin activity was evaluated.
  
  
  RESULTS
  The SIRS score, prothrombin time ratio, and antithrombin activity were associated with the 28-day mortality rate (P values = 0.013, 0.018, and 0.003, respectively, by multivariate analysis). A modified version of the JAAM-DIC diagnostic criteria using an antithrombin activity <70 % was capable of diagnosing the identical number (n = 706) and a similar severity of patients (mortality, 34.6 % versus 34.8 %).
  
  
  CONCLUSIONS
  Since anticoagulant therapy is expected to be more effective in patients with more severe coagulation disorders, the modified version of the JAAM-DIC diagnostic criteria might be useful for discriminating patients with sepsis who are good candidates for anticoagulant therapy.
authors.affiliation: Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan. toshiiba@cf6.so-net.ne.jp.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Iba
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, Chieti, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
authors.affiliation: Department of Haematology, Manchester Royal Infirmary, Oxford Road, Manchester, UK.
authors.forename: Jecko
authors.initials: J
authors.lastname: Thachil
authors.affiliation: Department of Molecular Laboratory Medicine, Mie University Graduate School of Medicine, 2-174, Tsu, Mie, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
authors.affiliation: Third Department of Internal Medicine, Kanazawa University, Graduate School of Medical Science, 13-1, Kanazawa, Japan.
authors.forename: Hidesaku
authors.initials: H
authors.lastname: Asakura
authors.affiliation: Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University Graduate School of Medicine, 1129, Izunokuni-shi, Shizuoka, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Recomodulin Strategy Planning Department, Pharmaceuticals Sales Division, Asahi Kasei Pharma Corporation, 1-105, Kanda, Tokyo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Kitamura
authors.affiliation: Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D003422:Critical Care / Q000458:organization & administration*; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis*; D005260:Female; D017408:Guidelines as Topic; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis; D012955:Societies, Medical / Q000458:organization & administration; D011795:Surveys and Questionnaires; D018180:Thrombomodulin / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D018180:Thrombomodulin
keywords: Anticoagulant; Antithrombin activity; Disseminated intravascular coagulation; Sepsis; Systemic inflammatory response syndrome