Score of Sivula et al for Disseminated Intravascular Coagulation (DIC) in the a Critically-Ill Patient

 

Patient selection: critically-ill

 

Based on: ISTH DIC model (04.18.04)

 

Modification: use of Owren type assay rather than the Quick PT

 

Parameters:

(1) platelet count

(2) PT activity (as percent of normal)

(3) plasma D-dimer concentration in mg/L

(4) plasma fibrinogen concentration

 

Parameter	Finding	Points
platelet count	>= 100,000 per µL	0
	50,000 to 99,999 per µL	1
	< 50,000 per µL	2
PT activity	>= 60%	0
	30 to 59.9%	1
	< 30%	2
D-dimer	<= 2.0 mg/L	0
	2.1 to 8.0 mg/L	2
	> 8.0 mg/L	3
fibrinogen concentration	>= 100 mg/dL	0
	< 100 mg/dL	1

 

where:

• PT activity in percent vs PT in seconds can be translated using a plot of percent activity vs time.

• The base value for D-dimer assay was 4 times the upper limit of normal (ULN) for the D-dimer assay. The upper value based on 4 times the base value (or 16 times the ULN).

 

total score =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 8

• The higher the score the greater the likelihood of overt DIC.

• A score >= 5 identified overt DIC in the original ISTH score.

 

Performance:

• Fibrinogen did not discriminate between overt and non-overt DIC while Owren-type prothrombin activity did.

• The plasma concentration of antithrombin III correlated with prognosis.