Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: A multicenter prospective study

Abstract

Disseminated intravascular coagulation (DIC) is a common life-threatening complication in critically ill patients. The diagnostic scoring systems of DIC enable a more prompt and accurate diagnosis of DIC, such as the International Society on Thrombosis and Haemostasis (ISTH), the Japanese Association for Acute Medicine (JAAM) and the Japanese Ministry of Health and Welfare (JMHW). This study prospectively evaluated the newly proposed Chinese DIC Scoring System (CDSS), which was conducted at 18 centers in China during a one-year period. Receiver operating characteristic (ROC) curves showed that, for diagnosis of DIC and for prediction of the 28-day all-cause mortality, the CDSS had larger areas under the ROC curve (AUCs) than the ISTH and the JAAM in different groups. The CDSS also had larger AUC than the JMHW for the ISTH DIC in non-infectious diseases. All of the AUCs of the CDSS were greater than 0.8, accompanied with both high sensitivity and high specificity. Furthermore, the CDSS score was an independent predictor of mortality (odds ratio, 1.882; p < 0.001), and could reflect the illness severity (p < 0.001 for Spearman's rank correlations with the scores of severity). In conclusion, the CDSS is worthy of promotion with a better diagnostic and prognostic value for DIC.

Figure 1

Relationships of the patients with disseminated intravascular coagulation (DIC) diagnosed by the four criteria. Left, comparisons in infection group; right, comparisons in non-infection group. CDSS, Chinese DIC Scoring System; JMHW, Japanese Ministry of Health and Welfare; ISTH, International Society on Thrombosis and Hemostasis; JAAM, Japanese Association for Acute Medicine; non-DIC, patients who didn’t meet the four criteria simultaneously. Numbers in parentheses are of nonsurvivors.

Figure 2

Corellations between the CDSS score and the APACHE II score, the SOFA score as well as the 28-day all-cause mortality. With the increase of the Chinese Disseminated Intravascular Coagulation Scoring System (CDSS) score on the day of diagnosis, average Acute Physiology and Chronic Health Evaluation (APACHE) II score (white bars), average Sequential Organ Failure Assesssment (SOFA) score (gray bars) and the 28-day all-cause mortality (line) of the patients increased simultaneously.