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. 2014 Apr 11;9(4):e93240.
doi: 10.1371/journal.pone.0093240. eCollection 2014.

DIC score in pregnant women--a population based modification of the International Society on Thrombosis and Hemostasis score

Offer Erez  1 , Lena Novack  2 , Ruthy Beer-Weisel  1 , Doron Dukler  1 , Fernanda Press  1 , Alexander Zlotnik  3 , Nandor Gabor Than  4 , Aaron Tomer  5 , Moshe Mazor  1
Affiliations

DIC score in pregnant women--a population based modification of the International Society on Thrombosis and Hemostasis score

Offer Erez et al. PLoS One. .

Abstract

Objectives: The objectives of this study were: 1) To determine the component needed to generate a validated DIC score during pregnancy. 2) To validate such scoring system in the identification of patients with clinical diagnosis of DIC.

Material and methods: This is a population based retrospective study, including all women who gave birth at the 'Soroka University Medical Center' during the study period, and have had blood coagulation tests including complete blood cell count, prothrombin time (PT)(seconds), partial thromboplastin time (aPTT), fibrinogen, and D-dimers. Nomograms for pregnancy were established, and DIC score was constructed based on ROC curve analyses.

Results: 1) maternal plasma fibrinogen concentrations increased during pregnancy; 2) maternal platelet count decreased gradually during gestation; 3) the PT and PTT values did not change with advancing gestation; 4) PT difference had an area under the curve (AUC) of 0.96 (p<0.001), and a PT difference ≥1.55 had an 87% sensitivity and 90% specificity for the diagnosis of DIC; 5) the platelet count had an AUC of 0.87 (p<0.001), an 86% sensitivity and 71% specificity for the diagnosis of DIC; 6) fibrinogen concentrations had an AUC of 0.95 (p<0.001) and a cutoff point ≤3.9 g/L had a sensitivity of 87% and a specificity of 92% for the development of DIC; and 7) The pregnancy adjusted DIC score had an AUC of 0.975 (p<0.001) and at a cutoff point of ≥26 had a sensitivity of 88%, a specificity of 96%, a LR(+) of 22 and a LR(-) of 0.125 for the diagnosis of DIC.

Conclusion: We could establish a sensitive and specific pregnancy adjusted DIC score. The positive likelihood ratio of this score suggests that a patient with a score of ≥26 has a high probability to have DIC.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The changes in the major components of the pregnancy modified DIC score: a)- PT- difference; b)- platelets; and c)- fibrinogen, with advancing gestations.
Figure 2
Figure 2. ROC curve analysis for the association of the major components of the pregnancy modified DIC score: a)- PT- difference; b)- platelets; and c)- fibrinogen, with the development of DIC.
Figure 3
Figure 3. ROC curve analysis for the association of the modified DIC score with the development of DIC.
See this image and copyright information in PMC

References

    1. Hahn L (1974) On fibrinolysis and coagulation during parturition and menstruation. Acta Obstet Gynecol Scand Suppl 28: 7–40. - PubMed
    1. Brenner B, Aharon A, Lanir N (2005) Hemostasis in normal pregnancy. Thromb Res 115 Suppl 1: 6–10. - PubMed
    1. Brenner B (2004) Haemostatic changes in pregnancy. Thromb Res 114: 409–14. - PubMed
    1. Lockwood CJ, Krikun G, Schatz F (1999) The decidua regulates hemostasis in human endometrium. Semin Reprod Endocrinol 17: 45–51. - PubMed
    1. Lockwood CJ, Krikun G, Schatz F (2001) Decidual cell-expressed tissue factor maintains hemostasis in human endometrium. Ann N Y Acad Sci 943: 77–88. - PubMed