Abstract

Objectives: To evaluate the diagnostic performance and prognostic value of a Chinese DIC Scoring System (CDSS).

Methods:1076 patients suspected of DIC were enrolled in 18 hospitals located across virtually the entire China. Scores of DIC were calculated on days 1-3 and 7, when DIC were diagnosed against the CDSS, the Japanese Ministry of Health and Welfare (JMHW) criteria, and the International Society on Thrombosis and Hemostasis (ISTH) criteria respectively. Illness severity and organ failure were assessed against the Acute Physiology and Chronic Health Evaluation (APACHE) II and the Sequential Organ Failure Assessment (SOFA) score. 28-day all-cause mortality was taken as a major prognostic sign.

Results: If 28-day all-cause mortality was used as a standard for DIC diagnosis, compared with the ISTH and JMHW criteria, the CDSS had the highest sensitivity (CDSS, 81.19%; ISTH, 71.29%; JMHW 74.26%, p<0.05) in patients without hematological malignancies and highest specificity (CDSS, 48.05%; ISTH, 32.90%; JMHW 32.90%, p<0.05) in patients with hematological malignancies. The area under the ROC curve (AUC) of the CDSS was largest in all patients. If the ISTH or JMHW criteria were taken as a standard for DIC diagnosis, the comparison between the CDSS and the other criteria yielded similar results. The odds ratios (ORs) for mortality were much higher in patients without hematological malignancies (CDSS, 14.1; ISTH, 8.6; JMHW 11.4) as compared with patients with hematological malignancies (CDSS, 3.1; ISTH, 2.5; JMHW 3.2). Moreover, in patients without hematological malignancies, the OR in the CDSS was conspicuous higher than that in ISTH and JMHW criteria. Spearman's rank test revealed that the DIC score bore a significant correlation with APACHE II and SOFA score. Besides, the survival rate of the DIC patients diagnosed against CDSS was significantly lower than that of those without DIC.

Conclusions: Compared with the ISTH and JMHW criteria, the CDSS has better diagnostic performance and prognostic value in DIC patients with different underlying diseases.

Figure 1
Figure 1.
View largeDownload slide
Disclosures

No relevant conflicts of interest to declare.

Topics:
apache ii score, blood coagulation, clinical decision support systems, coagulation process, hematologic neoplasms, hemostasis procedures, organ failure, severity of illness, thrombosis, international society of thrombosis and haemostasis

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2017 by The American Society of Hematology
2017
Sign in via your Institution