Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
BMJ Open. 2018 Dec 4;8(12):e024878. doi: 10.1136/bmjopen-2018-024878.
Disseminated intravascular coagulation (DIC) is a common and serious condition that can lead to poor outcomes in critically ill patients. To make a correct diagnosis and improve the outcome of patients with DIC, several organisations have put forward DIC scoring systems. However, which criteria is the best to use for diagnosing DIC remains a continuing controversy even though many studies have been conducted to validate the diagnostic accuracy of each DIC scoring system.
We will conduct a systematic review and meta-analysis of the diagnostic accuracy of DIC criteria for the prediction of mortality in critically ill adult patients. The primary objective is to assess the predictive values of the DIC criteria of Japanese Association for Acute Medicine, International Society on Thrombosis and Haemostasis, Japanese Ministry of Health and Welfare, Korean Society on Thrombosis and Hemostasis and Chinese Diagnostic Scoring System for 28-day mortality. We will search electronic bibliographic databases such as MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data. We will report study characteristics and assess methodological quality using the Quality of Diagnostic Accuracy Studies-II tool. If pooling is appropriate, we will compute parameter estimates using bivariate random-effects and hierarchical summary receiver operating characteristic models to produce summary receiver operating curves, summary operating points (pooled sensitivity and specificity) and 95% confidence regions around the summary operating points. Clinical and methodological subgroup and sensitivity analyses will be performed to explore heterogeneity.
This systematic review will help physicians diagnose DIC accurately and improve their clinical practice in critically ill settings. Approval from an ethics committee is not required. The findings will be disseminated through publication in a peer-reviewed journal.
CRD42017079350.
弥散性血管内凝血（DIC）是一种常见且严重的病症，可导致重症患者预后不良。为了做出正确的诊断并改善 DIC 患者的预后，一些组织提出了 DIC 评分系统。然而，尽管已经进行了许多研究来验证每个 DIC 评分系统的诊断准确性，但哪种标准最适合用于诊断 DIC 仍然存在争议。
我们将对用于预测重症成年患者死亡率的 DIC 标准的诊断准确性进行系统评价和荟萃分析。主要目的是评估日本急救医学协会、国际血栓与止血学会、日本厚生劳动省、韩国血栓与止血学会和中国 28 天死亡率诊断评分系统的 DIC 标准对死亡率的预测值。我们将检索 MEDLINE、EMBASE 和 Cochrane 对照试验中心注册库等电子文献数据库。两名审查员将独立筛选标题和摘要，进行全文审查并提取研究数据。我们将使用诊断准确性研究质量工具 II 报告研究特征和评估方法学质量。如果适合汇总，我们将使用双变量随机效应和层次汇总受试者工作特征模型计算参数估计，以生成汇总受试者工作特征曲线、汇总工作点（汇总敏感性和特异性）和汇总工作点周围的 95%置信区间。将进行临床和方法学亚组分析和敏感性分析，以探索异质性。
本系统评价将有助于医生准确诊断 DIC，并改善其在重症环境中的临床实践。不需要伦理委员会的批准。研究结果将通过发表在同行评议的期刊上传播。
PROSPERO 注册号：CRD42017079350。
