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.
ISTH Diagnosis (Decision)Decision Logic (Decision Table)
ISTH Diagnosis |
F | ISTH Score | ISTH Diagnosis | Description | |
"Overt DIC", "Consider non-overt DIC" | ||||
1 | <5 | "Consider non-overt DIC" | ||
2 | >=5 | "Overt DIC" | ||
References (Knowledge Source)Description
Ha SO, Park SH, et al. Performance evaluation of five differentiated disseminated intravascular coagulation (DIC) diagnostic criteria for predicting mortality in patients with complicated sepsis. J Korean Med Sci. 2016; 31: 1838-1845.
Levi M. Disseminated Intravascular Coagulation: New diagnostic criteria and supportive treatment strategies. 47th Scientific and Standardization Committee Meeting of the International Society on Thrombosis and Haemostasis. July 6-7, 2001. Paris, France. Medscape Cardiology. 2001. www.medscape.com. Accessed 08/22/2001.
Taylor FB Jr, Toh CH, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001; 86: 1327-1330.
Attachment
ISTH Score (Decision)Description
The first step is to determine if the patient has an underlying condition associated with DIC. If no underlying condition is present, then do not proceed further.
Decision Logic (Decision Table)
ISTH Score |
C+ | Platelet count per microliter | Elevation of the prothrombin time in seconds | Plasma fibrinogen in mg per dL | Fibrin monomer or degradation product | ISTH Score | Description | |
[0..5000000] | [0..5000] | "No increase", "Moderate increase", "Severe increase" | |||||
1 | <50000 | - | - | - | 2 | ||
2 | [50000..100000] | - | - | - | 1 | ||
3 | >100000 | - | - | - | 0 | ||
4 | - | <3 | - | - | 0 | ||
5 | - | [3..6) | - | - | 1 | ||
6 | - | >=6 | - | - | 2 | ||
7 | - | - | <=100 | - | 1 | ||
8 | - | - | >100 | - | 0 | ||
9 | - | - | - | "No increase" | 0 | ||
10 | - | - | - | "Moderate increase" | 2 | ||
11 | - | - | - | "Severe increase" | 3 | ||
Platelet count per microliter (Input Data)Semantic Link
| Hematology and Urine - Platelet count per microliter |
Elevation of the prothrombin time in seconds (Decision)Decision Logic (Literal Expression)
Elevation of the prothrombin time in seconds |
Prothrombin Time in seconds-Upper limit of the normal reference range for prothrombin time in seconds |