Evaluation of the diagnostic performance of fibrin monomer in disseminated intravascular coagulation

Abstract

Background: Fibrin-related markers (FRM) such as fibrin monomer (FM) and D-dimer (DD) are considered useful biological markers for the diagnosis of disseminated intravascular coagulation (DIC). However, no studies on the diagnostic performance of different FRMs have been published in Korea. The aim of this study was to evaluate the diagnostic performance of FM for DIC in comparison with DD.

Methods: The reference limit of FM was determined based on plasma sample data obtained from 210 control individuals. To evaluate diagnostic performance, FM data from the plasma samples of 139 patients with DIC-associated diseases were obtained for DIC scoring. FM was measured by immunoturbidimetry using STA-LIATEST FM (Diagnostica Stago, France). Patients were classified according to the DIC score as non-DIC, non-overt DIC, or overt DIC. ROC curve analyses were performed.

Results: The reference limit in the control individuals was determined to be 7.80 µg/mL. Patients with DIC-associated diseases were categorized as non-DIC (N=43), non-overt DIC (N=80), and overt DIC (N=16). ROC curve analyses showed that the diagnostic performance of FM was comparable to DD in both non-overt DIC and overt DIC (P=0.596 and 0.553, respectively). In addition, FM had higher sensitivity, specificity, positive predictive value, and negative predictive value than DD for differentiating overt DIC from non-DIC.

Conclusions: This study demonstrated that the diagnostic performance of FM for DIC was comparable to DD. FM might be more sensitive and more specific than DD in the diagnosis of overt DIC, but not non-overt DIC.

Keywords: Area under the curve (AUC); D-dimer (DD); Disseminated intravascular coagulation (DIC); Fibrin monomer (FM); Fibrin-related marker (FRM); ROC.

Fig. 1

Box plots of the plasma concentration of D-dimer (DD) (A) and fibrin monomer (FM) (B) in the 3 Groups. Data are expressed as median ±2SD. The statistical significance between the 2 groups was determined by 1-way analysis of variance.

Fig. 2

ROC curves of D-dimer (DD) and fibrin monomer (FM) for the diagnosis of disseminated intravascular coagulation (DIC); (A) In Group 2 (non-overt DIC), the area under the curve (AUC) of DD and FM were 0.638 and 0.610, respectively (P=0.596). (B) In Group 3 (overt DIC), the AUC of DD and FM were 0.819 and 0.858, respectively (P=0.553).