Diagnostic Scoring System for Disseminated Intravascular Coagulation (DIC)

Disseminated intravascular coagulation is a clinicopathological diagnosis of a disorder that is defined by the International Society on Thrombosis and Hemostasis (ISTH) as “an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes”. This condition typically originates in the microvasculature and can cause damage of such severity that it leads to organ dysfunction. It can be identified on the basis of a scoring system developed by the ISTH.

Diagnostic Scoring System for Disseminated Intravascular Coagulation (DIC)
Risk assessment: Does the patient have an underlying disorder known to be associated with overt DIC?

  • If yes, proceed with this algorithm
  • If no, do not use this algorithm

Order global coagulation tests (prothrombin time, platelet count, fibrinogen, fibrin-related marker)
Score the test results as follows:

  • Platelet count: 50,000 to 100,000 per mm3, 1 point; <50,000 per mm3, 2 points
  • Elevated fibrin-related marker (e.g., d-dimer, fibrin degradation products): no increase, 0 points; moderate increase, 2 points; strong increase, 3 points
  • Prolonged prothrombin time: <3 sec, 0 points; >/=3 sec but <6 sec, 1 point; >/=6 sec, 2 points
  • Fibrinogen level: >/=1 g per liter, 0 points; <1 g per liter, 1 point

Calculate the score as follows:

  • >/=5 points: compatible with overt DIC; repeat scoring daily
  • <5 points: suggestive of nonovert DIC; repeat scoring within next 1 to 2 days

 
 
References:

  1. Hunt BJ. Bleeding and coagulopathies in critical care. N Engl J Med. 2014 Feb 27;370(9):847-59.[Medline]
  2. Toh CH, Hoots WK; SSC on Disseminated Intravascular Coagulation of the ISTH. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost. 2007 Mar;5(3):604-6.[Medline]

Created May 29, 2014.

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