From the Guidelines
Diagnosing Disseminated Intravascular Coagulation (DIC) is best done using the International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria or the Sepsis-Induced Coagulopathy (SIC) scoring system.
Key Diagnostic Criteria
- The ISTH overt DIC criteria include platelet count, fibrin-related markers (D-dimer or FDP), prothrombin time (PT) ratio, and fibrinogen 1.
- The SIC scoring system, introduced in 2019, is designed to detect the compensated phase of DIC in sepsis and includes platelet count, prothrombin time (PT) ratio, SOFA score, and fibrinogen is not included 1.
Diagnostic Approach
- Both the ISTH overt DIC and SIC scoring systems can be used to diagnose sepsis-associated coagulopathy, with the SIC scoring system being more suitable for early and rapid diagnosis 1.
- The SIC scoring system has been shown to identify patients with sepsis who are at risk of developing overt DIC and may benefit from anticoagulant therapy 1.
Limitations and Future Perspectives
- The SIC scoring system has limitations, including low specificity and adaptivity, but it can be modified to include additional markers, such as thrombin-related markers or antithrombin activity, to improve its performance 1.
- Future studies are needed to evaluate the effectiveness of anticoagulant therapies in patients with sepsis-induced coagulopathy and DIC, using the SIC scoring system as a diagnostic tool 1.
From the Research
Diagnosing Disseminated Intravascular Coagulation (DIC)
Diagnosing DIC involves a combination of clinical and laboratory assessments. The International Society on Thrombosis and Haemostasis (ISTH) established a DIC diagnostic scoring system consisting of global haemostatic test parameters 2. This scoring system has been validated in diverse clinical settings.
Laboratory Tests for DIC
Several laboratory tests can be used to diagnose DIC, including:
- Prothrombin time (PT) and partial thromboplastin time (PTT) 3
- Fibrinogen/fibrin degradation products (FDP) and D-dimer 3
- Platelet count and fibrinogen levels 4, 3
- Soluble fibrin monomer (FM) and fibrin(ogen) split products (FSP) 5
Diagnostic Efficiency of Laboratory Tests
The combination of FDP and D-dimer has been shown to have the highest diagnostic efficiency for DIC, with a sensitivity of 91% and specificity of 94% 3. Other tests, such as PT, PTT, and platelet count, have lower sensitivity and specificity.
Clinical Assessment
Clinical assessment is also crucial in diagnosing DIC. The ISTH scoring system takes into account clinical observations, such as bleeding or thrombosis, in addition to laboratory results 2, 6. The diagnosis of DIC should be based on a combination of clinical and laboratory findings.
Monitoring and Management
Once DIC is diagnosed, it is essential to monitor the patient's condition closely and adjust treatment accordingly. The cornerstone of treatment is to address the underlying condition that triggered DIC 2, 6, 5. Transfusion of platelets or plasma may be necessary in some cases, and anticoagulant therapy may be considered in patients with thrombosis 6.