Sivula et al used a modified score to describe disseminated intravascular coagulation (DIC) in critically-ill patients. The authors are from Helsinki University Central Hospital.
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.
Specialty: Hematology Oncology, Clinical Laboratory