Efficacy evaluation of D-dimer and modified criteria in overt and nonovert disseminated intravascular coagulation diagnosis.

INTRODUCTION

D-dimer (D-D) was shown to be an important indicator for the diagnosis of overt disseminated intravascular coagulation (DIC) and nonovert DIC. However, its diagnostic cutoff value in the clinic is not clearly defined.

METHODS

D-D, fibrinogen degradation products (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), antithrombin (AT), and blood platelet count (PLT) of 360 cases were used to assess the diagnostic efficacy of D-D (InnovanceR reagent) for the diagnosis of DIC and nonovert DIC, compared to, or combined with, other DIC coagulation indicators.

RESULTS

When D-D > 3.0 μg/mL was used as the cutoff, the sum of diagnostic sensitivity and specificity reached maximum values for DIC and nonovert DIC, whereas the sum of misdiagnoses and missed diagnosis rate was minimal. Excluding D-D, AT, or Fg, but not TT, from the test combination reduced the diagnostic sensitivity of DIC or nonovert DIC by various degrees. The area under the receiver-operating characteristic curve of D-D for diagnosing DIC and nonovert DIC was 0.97 and 0.98, respectively. Combining two factors, D-D > 3.0 μg/mL and FDP > 10 mg/L, increased the sensitivity and specificity for the diagnosis of DIC and nonovert DIC.

CONCLUSION

The cutoff value of D-D is >3.0 μg/mL; combined testing of D-D and FDP could be used as primary screening for diagnosing DIC and nonovert DIC in clinical practice.