Disseminated Intravascular Coagulation (DIC) Score

Determines risk of DIC in patients diagnosed with thrombosis associated conditions.

There is more information about the score and about the original study in the text below the calculator.


The disseminated intravascular coagulation (DIC) score evaluates patients who suffer from conditions that are associated with thrombosis in order to determine risk of intravascular activation of coagulation.

The score is passed on four parameters: platelet count, fibrin markers, prothrombin time and fibrinogen level.


The result varies from 0 to 8 and a cut off of 5 points is applied with 93% sensitivity and 98% specificity in determining likelihood of disseminated intravascular coagulation.

The score should be repeated daily if the symptoms and laboratory results persist.


1

Platelet count

2

Increase in fibrin markers

3

Prothrombin time prolongation

4

Fibrinogen level

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The scoring method explained

This is a stratifying tool for risk of disseminated intravascular coagulation that is addressed to patients with a thrombosis associated underlying disorder.

The score was developed in 2009 by The International Society of Thrombosis and Haemostasis (ISTH) (a study by Levi et al.) and is based on the following definition of DIC: an acquired syndrome characterized by intravascular activation of coagulation, due to various causes.

There are four parameters that are monitored:

Score items Answer choices (points) Description
Platelet count More than 100,000/microL (0)
Between 50,000/microL - 100,000/microL (1)
Less than 50,000/microL (2)
The lower the platelet count, the higher the likelihood of DIC.
Increase in fibrin markers No change (0)
Moderate rise (2)
Strong rise (3)
Examples of Fibrin Markers that are monitored for any changes include D-dimer and fibrin split products.
Prothrombin time prolongation 3 seconds or less (0)
More than 3 seconds but less than 6 seconds (1)
More than 6 seconds (2)
The higher the time, usually more than 3 - 6 seconds, the higher the likelihood of DIC.
Fibrinogen level Greater than 1 g/L (0)
Less than 1 g/L (1)
Because the determination has a cut off of 1 g/L, values below the cut off pose a higher risk.
 

Result interpretation

Each of the above four parameters are attributed a numeric value. These are summed to provide the final score that varies between 0 and 8.

A cut off of 5 points is applied with 93% sensitivity and 98% specificity for DIC so there are two groups of results:

■ Scores between 0 and 4 are not consistent with disseminated intravascular coagulation, however, if symptoms persist, the score should be reapplied every 24 hours.

■ Scores between 5 and 8 are consistent with DIC and laboratory determinations should continue to be monitored, along with the daily application of the score.

 

DIC medical guidelines

Intravascular activation of coagulation occurs as a secondary complication to an underlying disorder, the most common being sepsis and malignancy (especially leukemia). Less common DIC triggers include:

■ Trauma (especially brain trauma, crush syndrome);

■ Severe toxic reactions;

■ Organ failure;

■ Incompatible blood transfusion, transplant reactions;

■ Large aortic aneurysms;

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

The thrombin dependent coagulation mechanism is activated in a profuse way which leads to hemorrhage or to thrombosis in the subacute or chronic form.

DIC presentation is consistent with symptoms of the underlying condition but the patient may also have large bruises or spontaneous bleeding at venepuncture. Other characteristic symptoms include confusion, fever, petechia, purpura, adult respiratory distress syndrome (ARDS) or skin necrosis.

There are three criteria that must be met for DIC diagnosis:

■ An underlying disorder associated with DIC;

■ Clinical findings positive for DIC;

■ Laboratory findings* consistent with DIC (evidence of thrombin and plasmin activation).

*Laboratory tests involve a clotting screening that consists of:

■ Prothrombin time (PT);

■ Activated partial thromboplastin time (aPTT);

■ Platelet counts;

■ Fibrinogen level.

The above can be associated with a D-dimer test which is the most specific investigation. Fibrin degradation products test (FDPs) is also used, but has less specificity as it appears in other conditions, such as deep venous thrombosis (DVT).

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).

Prognosis depends on the outcome of the primary condition and on how extensive is the intravascular thrombosis. In serious complications, mortality rates are between 10 and 50% (the latter being recorded in patients with sepsis).

 

Original source

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

Other references

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

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


App Version: 1.0.1

Coded By: MDApp

Specialty: Hematology

System: Cardiovascular

Objective: Risk Prediction

Type: Score

No. Of Items: 4

Year Of Study: 2009

Abbreviation: DIC

Article By: Denise Nedea

Published On: June 22, 2017 · 07:02 AM

Last Checked: June 22, 2017

Next Review: June 22, 2018