Disseminated Intravascular Coagulation (DIC) Score Calculator

How does this Disseminated Intravascular Coagulation (DIC) score calculator work?

This health tool evaluates the presence of disseminated intravascular coagulation for patients with an associated underlying disorder.

The score was developed by The International Society of Thrombosis and Haemostasis (ISTH) that has defined DIC as an acquired syndrome characterized by intravascular activation of coagulation, due to different causes.

The DIC score calculator accounts of the following four parameters:

■ Platelet count – there are three categories of count, one below 50,000/microL, one between 50,000/microL and 100,000/microL and one above 100,000/microL. The lower the platelet count, the higher the likelihood of DIC.

■ Increase in fibrin markers – evaluates any change in marker values, and quantifies existing change by moderate or strong rise. Examples of Fibrin Markers include D-dimer and fibrin split products.

■ Prothrombin time prolongation – the higher the time, usually more than 3 - 6 seconds, the higher the possibility of DIC.

■ Fibrinogen level – determination with a cut off of 1 g/L. Values below the cut off pose higher risk.

DIC score interpretation

Each of the four parameters evaluated above have values that are weighted with a number of points varying from 0 to 3. By summing the points given to the choices, a final result between 0 and 8 is obtained.

A cut off of 5 points is applied with 93% sensitivity and 98% specificity for DIC, therefore 2 types of possible results emerge:

■ Scores between 0 and 4 are not consistent with disseminated intravascular coagulation. If symptoms and laboratory determinations persist, the indication is to repeat the score after 24, 48 hours.

■ Scores between 5 and 8 are consistent with disseminated intravascular coagulation. The score needs to be repeated daily with every update in laboratory determinations.

DIC medical guidelines

Disseminated intravascular coagulation needs to be associated with an underlying disorder, where it acts as secondary complication.

Common causes are:

■ Sepsis;

■ Malignancy (especially leukaemias).

Less common causes are:

■ Trauma (especially brain trauma, crush syndrome);

■ Severe toxic reactions;

■ Organ failure;

■ Large aortic aneurysms;

■ Incompatible blood transfusion, transplant reactions;

■ Obstetric (amniotic fluid embolism, abruptio placenta, eclampsia).

Thrombin dependent coagulation mechanism is activated in a profuse way, which in turn may lead (most often) to hemorrhage or to thrombosis in the subacute or chronic form. In its most severe form, it leads to decompensation and organ failure.

Presentation is often characteristic for the underlying condition that has complicated into DIC but large bruises or spontaneous bleeding at venepuncture may also be present in acute conditions. Other symptoms include confusion, fere, adult respiratory distress syndrome (ARDS), petechia, purpura, skin necrosis.

DIC diagnosis needs to meet three criteria:

1. An underlying disorder associated with DIC.
2. Clinical findings positive for DIC.
3. Laboratory findings consistent with DIC (evidence of thrombin and plasmin activation).

The main clotting screening consists of:

■ Prothrombin time (PT);

■ Activated partial thromboplastin time (aPTT);

■ Platelet counts;

■ Fibrinogen level.

The D-dimer test is the most specific investigation for DIC while Fibrin degradation products (FDPs) is less specific and appears in other conditions as well, i.e. deep vein thrombosis (DVT).

First part of treatment consists in the management of the underlying condition, for example infections with antibiotic regimen, trauma with surgery etc. In some situations (high bleeding risk, platelet count of <50 x 10⁹/L platelet transfusion is recommended.

Prognosis depends on the outcome of the primary condition and the extent of the intravascular thrombosis. Mortality from serious complications varies between 10 and 50% with the higher rates being registered in patients with sepsis.

References

1) Levi M, Toh CH, Thachil J, Watson HG. (2009) Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol; 145(1):24-33.

2) Voves C, Wuillemin WA, Zeerleder S. (2006) International Society on Thrombosis and Haemostasis score for overt disseminated intravascular coagulation predicts organ dysfunction and fatality in sepsis patients. Blood Coagul Fibrinolysis; 17(6):445-51.

3) The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. Toh CH, Hoots WK; SSC on Disseminated Intravascular Coagulation of the ISTH. (2007) J Thromb Haemost; 5(3):604-6.

4) Kaneko T, Wada H. (2011) Diagnostic criteria and laboratory tests for disseminated intravascular coagulation. J Clin Exp Hematop; 51(2):67-76.

5) Rostom A, Khaled M, Afify M, EL-Sherif A. (2013) Applications of the international scoring system for Disseminated Intravascular Coagulopathy (DIC) and its interaction with Sequential Organ Failure Assessment Score (SOFA) in prediction of prognosis and final outcome in ICU. The Egyptian Journal of Critical Care Medicine. 1(1):33–41.