Abstract
Evaluation of the modified Japanese Ministry Health, Labour and Welfare (JMHLW) diagnostic criteria for DIC to detect the early phase of DIC
Introduction: Disseminated intravascular coagulation (DIC) is a syndrome characterized by the systemic activation of blood coagulation, which generates intravascular thrombin and fibrin, resulting in the thrombosis of small-to medium-sized vessels and ultimately organ dysfunction and severe bleeding. Three different diagnostic criteria incorporating similar global coagulation tests have been established by the International Society of Thrombosis and Haemostasis (ISTH), Japanese Ministry Health, Labour and Welfare (JMHLW) and Japanese Association of Acute Medicine (JAAM). The JMHLW score is well correlated with the severity of DIC and can be used to predict the outcome of the disease, however, it has a relatively low sensitivity for the early phase of DIC (pre-DIC).
Material and Methods: The Modified JMHLW criteria are shown in the Table 1. From 1996 to 2014, 282 patients with hematopoietic disorder type, 220 patients with infection type and 249 patients with other type were retrospectively diagnosed with DIC according to the JMHW criteria. There were 184 patients with pre-DIC and 256 patients without DIC.
Modified Japanese Ministry Health, Labor and Welfare criteria for DIC
| . | Hematopoietic disorder type . | Other type . | Infection type . |
|---|---|---|---|
| Platelet count (X107/ml) | none | 8 < < 12: 1 point, 5 < < 8: 2 points, (> 30% decrease: plus 1 point) < 5: 3 points | |
| FDP (ƒÊg/ml) | 10 < < 20: 1 point, 20 < < 40; 2 points, 40< : 3 points | ||
| Fibrinogen (g/L) | 1 < < 1.5 : 1 point, < 1: 2 points | none | |
| PT ratio | 1.25 < < 1.67: 1 point, 1.67 < : 2 points | ||
| AT (%) | < 70 : 1 point | ||
| TAT or SF | 2X (upper limit of normal range): 1 point | ||
| DIC | 4 points = or < | 6 points = or < | 5 points = or < |
| . | Hematopoietic disorder type . | Other type . | Infection type . |
|---|---|---|---|
| Platelet count (X107/ml) | none | 8 < < 12: 1 point, 5 < < 8: 2 points, (> 30% decrease: plus 1 point) < 5: 3 points | |
| FDP (ƒÊg/ml) | 10 < < 20: 1 point, 20 < < 40; 2 points, 40< : 3 points | ||
| Fibrinogen (g/L) | 1 < < 1.5 : 1 point, < 1: 2 points | none | |
| PT ratio | 1.25 < < 1.67: 1 point, 1.67 < : 2 points | ||
| AT (%) | < 70 : 1 point | ||
| TAT or SF | 2X (upper limit of normal range): 1 point | ||
| DIC | 4 points = or < | 6 points = or < | 5 points = or < |
AT: antithrombin, TAT: thrombin AT complex, SF: soluble fibrin
Results: The agreement rate between the JMHLW and modified JMHLW criteria was 95.9%. The diagnosis rate of pre-DIC was 0% using the JMHLW criteira, 8.3% using the ISTH diagnostic criteria, 63.0% using the JAA criteria and 38.6% using the modified JMHLW criteira for DIC. The mortality of DIC was 42.5% using the JMHLW criteria, 45.5% using the ISTH criteria, 41.3% using the JAA criteria and 42.6% using the modified JMHLW criteria.
Discussion and conclusion: The agreement rate between the JMHLW and modified JMHLW criteria is high. As the modified JMHLW criteria adds the score for antithrombin (AT) activity, thrombin-AT complex (TAT) or soluble fibrin (SF), these criteria increase the sensitivity for pre-DIC.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
