The Japanese Society of Thrombosis and Hemostasis (JSTH) has published criteria for the diagnosis of Disseminated Intravascular Coagulation (DIC). This recognizes 3 clinical types, one of which involves infectious disease.
Patient selection: suspected DIC with an infectious disease
For infectious disease the plasma fibrinogen is not included.
Parameters:
(1) prothrombin time ratio
(2) platelet count per µL
(3) platelet count per µL 24 hours before
(4) fibrin degradation products in µg/mL (mg/L)
(5) antithrombin in percent of normal
(6) molecular marker (soluble fibrin, thrombin antithrombin complex, soluble fibrin monomer complex) as multiple of upper limit of normal
(7) liver failure
prothrombin time ratio =
= (prothrombin time in seconds) / (upper limit of normal in seconds)
molecular marker ratio =
= (molecular marker value) / (upper limit of normal)
|
Parameter
|
Finding
|
Points
|
|
prothrombin time ratio
|
< 1.25
|
0
|
|
|
1.25 to 1.66
|
1
|
|
|
>= 1.67
|
2
|
|
platelet count
|
> 120,000 per µL
|
0
|
|
|
80,001 to 120,000
|
1
|
|
|
50,001 to 80,000
|
2
|
|
|
<= 50,000 per µL
|
3
|
|
fibrin degradation products
|
< 10 µg/mL
|
0
|
|
|
10 to 19.9 µg/mL
|
1
|
|
|
20 to 39.9 µg/mL
|
2
|
|
|
>= 40 µg/mL
|
3
|
|
antithrombin
|
> 70%
|
0
|
|
|
<= 70%
|
1
|
|
molecular marker ratio
|
< 2
|
0
|
|
|
>= 2
|
1
|
|
liver failure
|
absent
|
0
|
|
|
present
|
-3
|
total score =
= SUM(points for the parameters) + (1 point if there was a decrease >= 30% in the platelet count within 24 hours)
Interpretation:
• minimum score: -3
• maximum score: 11
• A score >= 6 indicates DIC.
