The Subcommittee on DIC for the Scientific and Standardization Committee (SSC) of the International Society on Thrombosis and Haemostasis (ISTH) has developed a definition and scoring algorithm for disseminated intravascular coagulation (DIC).
Definition: DIC is an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes. It can originate from and cause damage to the microvasculature, which, if sufficiently severe, can produce organ dysfunction.
To use the scoring algorithm:
Step 1: Determine if the patient has an underlying condition associated with DIC. If no underlying condition is present, then do not proceed further.
Step 2: Order screening coagulation tests:
(2a) platelet count
(2b) prothrombin time
(2c) fibrinogen
(2d) soluble fibrin monomers or fibrin degradation products
|
Screening Test
|
Finding
|
Points
|
|
platelet count
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> 100,000 per µL
|
0
|
|
|
50,000 – 100,000 per µL
|
1
|
|
|
< 50,000 per µL
|
2
|
|
prothrombin time
|
(PT – upper limit of reference range) < 3 seconds
|
0
|
|
|
(PT – upper limit of reference range) = 3 to 5.9 seconds
|
1
|
|
|
(PT – upper limit of reference range) >= 6.0 seconds
|
2
|
|
fibrinogen
|
> 100 mg/dL
|
0
|
|
|
<= 100 mg/dL
|
1
|
|
fibrin monomer or degradation product
|
no increase
|
0
|
|
|
moderate increase
|
2
|
|
|
severe increase
|
3
|
where:
• According to the Medscape table, there are gaps at the breakpoints for platelet count 100,000; prothrombin time 6 seconds; fibrinogen 100 mg/dL.
• A mild increase in fibrin monomer or degradation product is not scored in the table. It begs to be scored 1 point.
DIC score =
= SUM(points for the 4 items)
Interpretation:
• minimum score: 0
• maximum score: 8
• A score >= 5 is compatible with overt DIC. Scoring is repeated daily in order to characterize the severity and course of the DIC.
• A score < 5 is suggestive for non-overt DIC. Scoring should be repeated every 1-2 days until recovered in order to detect progression to overt DIC.
