The Utility of a Diagnostic Scoring System for Disseminated Intravascular Coagulation

From the early 1970s to 1980s, several disseminated intravascular coagulation (DIC) diagnostic criteria were published. 1 Colman R.W. Robby S.J. Minna J.D. Disseminated intravascular coagulation (DIC): an approach. Am J Med. 1972; 52: 679-689 Abstract Full Text PDF PubMed Scopus (224) Google Scholar , 2 Spero J.A. Lewis J.H. Hasiba U. Disseminated intravascular coagulation Findings in 346 patients. Thromb Haemost. 1980; 43: 28-33 PubMed Google Scholar , 3 Kobayashi N. Maekawa T. Takada M. et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibl Haematol. 1983; 49: 265-275 PubMed Google Scholar At that time, there was already recognition of the clinical importance of DIC, and DIC was also called “Death Is Coming.” 2 Spero J.A. Lewis J.H. Hasiba U. Disseminated intravascular coagulation Findings in 346 patients. Thromb Haemost. 1980; 43: 28-33 PubMed Google Scholar However, no universally accepted definition or diagnostic algorithm for DIC has existed until recently. In 1988, the Japanese Ministry of Health and Welfare (JMHW) proposed a scoring system for DIC by revising their 1983 version of the criteria. 3 Kobayashi N. Maekawa T. Takada M. et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibl Haematol. 1983; 49: 265-275 PubMed Google Scholar , 4 Wada H. Gabazza E.C. Asakura H. et al. Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Haemostasis (ISTH) and of the Japanese Ministry of Health and Welfare for overt DIC. Am J Hematol. 2003; 74: 17-22 Crossref PubMed Scopus (130) Google Scholar The Scientific Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis (ISTH) subsequently announced overt and nonovert DIC scoring systems partly based on the 1988 JMHW scoring system in the early 2000s. 5 Taylor F.B. Toh C.H. Hoots W.K. et al. Toward definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001; 86: 1327-1330 PubMed Google Scholar In this communication, the ISTH also provided a clear and universally accepted definition of DIC for the first time. During the 1990s, structural and functional studies clarified the tight interplay between coagulation and inflammation. 6 Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference committeeAmerican College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use innovative therapies in sepsis. Crit Care Med. 1992; 20: 864-874 Crossref PubMed Scopus (4850) Google Scholar , 7 Esmon C.T. Fukudome K. Mather T. et al. Inflammation, sepsis, and coagulation. Haematologica. 1999; 84: 254-259 PubMed Google Scholar These studies supported an important role of systemic inflammatory response syndrome (SIRS) in the development of DIC in critically ill patients. 7 Esmon C.T. Fukudome K. Mather T. et al. Inflammation, sepsis, and coagulation. Haematologica. 1999; 84: 254-259 PubMed Google Scholar , 8 Rangel-Frausto M.S. Pittet D. Costigan M. et al. The natural history of the systemic inflammatory response syndrome (SIRS) A prospective study. JAMA. 1995; 273: 117-123 Crossref PubMed Scopus (1705) Google Scholar DIC in turn contributes to the development of multiple organ dysfunction syndrome (MODS) and its complications in this patient group associated with SIRS. 9 Levi M. ten Cate H. Disseminated intravascular coagulation. N Engl J Med. 1999; 341: 586-592 Crossref PubMed Scopus (903) Google Scholar Based on this evidence and referring to the previous criteria, the Japanese Association for Acute Medicine (JAAM) DIC study group developed a new DIC scoring system for critically ill patients. 10 Gando S. Iba T. Eguchi Y. et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. 2006; 34: 625-631 Crossref PubMed Scopus (382) Google Scholar , 11 Gando S. Saitoh D. Ogura H. et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med. 2008; 36: 145-150 Crossref PubMed Scopus (166) Google Scholar Both the ISTH and the JAAM DIC scoring systems have been prospectively validated, and their usefulness in various clinical situations, including the critical care setting, has been confirmed. 10 Gando S. Iba T. Eguchi Y. et al. A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med. 2006; 34: 625-631 Crossref PubMed Scopus (382) Google Scholar , 11 Gando S. Saitoh D. Ogura H. et al. Natural history of disseminated intravascular coagulation diagnosed based on the newly established diagnostic criteria for critically ill patients: results of a multicenter, prospective survey. Crit Care Med. 2008; 36: 145-150 Crossref PubMed Scopus (166) Google Scholar , 12 Bakhtiari K. Meijers J.C. de Jong E. et al. Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation. Crit Care Med. 2004; 32: 2416-2421 Crossref PubMed Scopus (338) Google Scholar , 13 Toh C.H. Hoots W.K. SSC on disseminated intravascular coagulation of the ISTHThe scoring system of the Scientific and Standardization Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost. 2007; 5: 604-606 Crossref PubMed Scopus (254) Google Scholar Although some comments on these have been proposed, 14 Dempfle C.E. Comparing DIC scores: not an easy task indeed. Thromb Res. 2009; 124: 651-652 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar clinical comparisons for these criteria have been published. 15 Takemitsu T. Wada H. Hatada T. et al. Prospective evaluation of three different diagnostic criteria for disseminated intravascular coagulation. Thromb Haemost. 2011; 105: 40-44 Crossref PubMed Scopus (77) Google Scholar Recently, two guidelines and one expert consensus about the DIC diagnosis and its treatment of DIC have been announced from three societies of thrombosis and hemostasis. 16 Levi M. Toh C.H. Thachil J. et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol. 2009; 145: 24-33 Crossref PubMed Scopus (755) Google Scholar , 17 Wada H. Asakura H. Okamoto K. et al. Expert consensus for the treatment of disseminated intravascular coagulation in Japan. Thromb Res. 2010; 125: 6-11 Abstract Full Text Full Text PDF PubMed Scopus (168) Google Scholar , 18 Di Nisio M. Baudo F. Cosmi B. et al. Diagnosis and treatment of disseminated intravascular coagulation: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res. 2012; 129 (e177–e84) PubMed Google Scholar Comments for these guidelines have also been proposed. 19 Iba T. Asakura H. Comparison between British and Japanese guidelines for the diagnosis and treatment of disseminated intravascular coagulation. Br J Haematol. 2010; 149: 461-462 Crossref PubMed Scopus (6) Google Scholar , 20 Levi M. Japanese consensus for disseminated intravascular coagulation (DIC): is it a small world after all?. Thromb Res. 2010; 125: 4-5 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar , 21 Gando S. The SISET incorrectly cited the JAAM DIC scoring system. Thromb Res. 2012; 129: 660 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar KEY POINTS •DIC should be recognized as a serious condition that should be diagnosed and treated as early as possible in the critical care setting. •Three diagnostic scoring systems for DIC published by the ISTH, the JAAM, and the JMHW are now available. •It would be better to select the scoring system based on a full understanding of the diagnostic properties. •DIC should be recognized as a serious condition that should be diagnosed and treated as early as possible in the critical care setting. •Three diagnostic scoring systems for DIC published by the ISTH, the JAAM, and the JMHW are now available. •It would be better to select the scoring system based on a full understanding of the diagnostic properties.