To retrospectively validate the prognostic value of the latest Chinese disseminated intravascular coagulation (DIC) scoring system (CDSS) in hematological malignancies, 260 patients with confirmed hematological malignancies and suspected DIC in West China Hospital between 2011 and 2015 were included in this study. We evaluated via univariate and multivariate analyses the diagnostic biomarkers, and the cutoff levels used in the CDSS, except those for fibrinogen, were found to be valid. In subgroup analyses, the value of fibrinogen was found to be mainly unfit for the acute promyelocytic leukemia group. Forty-six patients (17.7%) had elevated fibrinogen levels (>4 g/L) and tended to have a poor prognosis, and thus we redetermined the cutoff value of fibrinogen (<1 g/L or >4 g/L was defined as abnormal). As a result, all of the markers used in the CDSS had prognostic value (including for the promyelocytic leukemia group); meanwhile, this modification also resulted in a larger area under the receiver operating characteristic curve compared to the CDSS and the International Society on Thrombosis and Haemostasis score. We believe that, with regard to prognosis prediction, this cutoff value modification for fibrinogen is preferable for DIC patients with a tendency toward severe hypofibrinogenemia. However, a multicenter, prospective study is needed to validate this possibility.

Keywords:
Chinese disseminated intravascular coagulation scoring system, Disseminated intravascular coagulation, Fibrinogen, Prognosis, Hematological malignancy
1.
Wada H, Matsumoto T, Yamashita Y: Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care 2014;2:15.
2.
Levi M: Disseminated intravascular coagulation in cancer patients. Best Pract Res Clin Haematol 2009;22:129-136.
3.
Wada H, Thachil J, Di Nisio M, Mathew P, Kurosawa S, Gando S: Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost 2013;2:761-767.
4.
Franchini M, Di Minno MN, Coppola A: Disseminated intravascular coagulation in hematologic malignancies. Semin Thromb Hemost 2010;36:388-403.
5.
Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M: Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001;86:1327-1330.
6.
Kobayashi N, Maekawa T, Takada M, Tanaka H, Gonmori H: Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibl Haematol 1983;49:265-275.
7.
Gando S, Iba T, Eguchi Y, Ohtomo Y, Okamoto K, Koseki K: A muticenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med 2006;34:625-631.
8.
Manzhi Wang, Haiming Kou, Jun Deng, Huafang Wang, Tao Guo, Heng Mei, Yu Hu: Retrospective evaluation of new Chinese diagnostic scoring system for disseminated intravascular coagulation. PLoS One 2015;10:e0129170.
9.
Franchini M, Frattini F, Crestani S, Bonfanti C: Bleeding complications in patients with hematologic malignancies. Semin Thromb Hemost 2013;39:94-100.
10.
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;145:24-33.
11.
Levi M, Meijers JC: DIC: which laboratory tests are most useful. Blood Rev 2011;25:33-37.
12.
Bates SM: D-dimer assays in diagnosis and management of thrombotic and bleeding disorders. Semin Thromb Hemost 2012;38:673-682.
13.
Ruan XiaoLan, Li Sheng, Guo Yi: Value of D-dimer and fibrinogen degradation products for the diagnosis of disseminated intravascular coagulation: a meta-analysis. J Clin Hematol (China) 2013;26:615-618.
14.
Gris JC, Faillie JL, Cochery-Nouvellon E, Lissalde-Lavigne G, Lefrant JY: ISTH overt disseminated intravascular coagulation score in patients with septic shock: automated immunoturbidimetric soluble fibrin assay vs. D-dimer assay. J Thromb Haemost 2011;9:1252-1255.
15.
Dhainaut JF, Yan SB, Joyce DE, Pettilä V, Basson B, Brandt JT, Sundin DP, Levi M: Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost 2004;2:924-1933.
16.
Dhainaut JF, Yan SB, Joyce DE, Pettilä V, Basson B, Brandt JT, Sundin DP, Levi M: Prospective validation of the International Society of Thrombosis and Haemostasis scoring system for disseminated intravascular coagulation. Crit Care Med 2004;32:2416-2421.
17.
Soundar EP, Jariwala P, Nguyen TC, Eldin KW, Teruya J: Evaluation of the International Society on Thrombosis and Haemostasis and institutional diagnostic criteria of disseminated intravascular coagulation in pediatric patients. Am J Clin Pathol 2013;139:812-816.
18.
Thachil J, Toh CH: Current concepts in the management of disseminated intravascular coagulation. Thromb Res 2012;4:54-59.
19.
Menell JS, Cesarman GM, Jacovina AT, McLaughlin MA, Lev EA, Hajjar KA: Annexin II and bleeding in acute promyelocytic leukemia. N Engl J Med 1999;340:994-1004.
20.
Sarris A, Cortes J, Kantarjian H, Pierce S, Smith T, Keating M, Koller C, Kornblau S, O'Brien S, Andreeff M: Disseminated intravascular coagulation in adult acute lymphoblastic leukemia: frequent complications with fibrinogen levels less than 100 mg/dl. Leuk Lymphoma 1996;21:85-92.
21.
Wada H, Mori Y, Okabayashi K, Gabazza EC, Kushiya F, Watanabe M, Nishikawa M, Shiku H, Nobori T: High plasma fibrinogen level is associated with poor clinical outcome in DIC patients. Am J Hematol 2003;72:1-7.
22.
Gralnick HR, Marchesi S, Givelber H: Intravascular coagulation in acute leukemia: clinical and subclinical abnormalities. Blood 1972;40:709-718.
23.
Barbui T, Falanga A: Disseminated intravascular coagulation in acute leukemia. Semin Thromb Hemost 2001;27:593-604.
24.
Dixit A, Chatterjee T, Mishra P, Kannan M, Choudhry DR, Mahapatra M, Choudhry VP, Saxena R: Disseminated intravascular coagulation in acute leukemia at presentation and during induction therapy. Clin Appl Thromb Hemost 2007;13:292-298.
25.
Wada H, Sase T, Yamaguchi M: Hypercoagulant states in malignant lymphoma. Exp Oncol 2005;27:179-185.
26.
Tallman MS, Lefèbvre P, Baine RM, Shoji M, Cohen I, Green D, Kwaan HC, Paietta E, Rickles FR: Effects of all trans retinoic acid or chemotherapy on the molecular regulation of systemic blood coagulation and fibrinolysis in patients with acute promyelocytic leukemia. J Thromb Haemost 2004;2:1341-1350.
27.
Di Bona E, Avvisati G, Castaman G, Luce Vegna M, De Sanctis V, Rodeghiero F, Mandelli F: Early haemorrhagic morbidity and mortality during remission induction with or without all-trans retinoic acid in acute promyelocytic leukaemia. Br Haematol 2000;108:689-695.
28.
Fenaux P, Chomienne C, Degos L: Treatment of acute promyelocytic leukaemia. Best Pract Res Clin Haematol 2001;14:153-174.
29.
Sase T, Wada H, Yamaguchi M, Ogawa S, Kamikura Y, Nishikawa M, Kaneko T, Abe Y, Nishioka J, Nobori T: Haemostatic abnormalities and thrombotic disorders in malignant lymphoma. Thromb Haemost 2005;93:153-159.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.