评价国际血栓与止血学会评分系统及其改良版在弥散性血管内凝血诊断中的应用：来自印度南部的一项初步研究。
Evaluation of the International Society on Thrombosis & Haemostasis scoring system & its modifications in diagnosis of disseminated intravascular coagulation: A pilot study from southern India.
机构信息
Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
出版信息
Indian J Med Res. 2022 Feb;155(2):306-310. doi: 10.4103/ijmr.IJMR_1236_19.
BACKGROUND & OBJECTIVES: Diagnosis of disseminated intravascular coagulation (DIC) rests primarily on the clinical profile along with supportive laboratory tests. The International Society on Thrombosis and Haemostasis (ISTH) had proposed a scoring system for the diagnosis of overt DIC. However, fibrinogen values which are supposed to be low are often found to be elevated due to the associated inflammation seen in some cases. Moreover, peripheral smear is known to show schistocytes, which is also not included in the score. This study was done to evaluate ISTH scoring system and its modifications in suspected DIC.
METHODS
Fifty-six patients were enrolled for the present study of whom; in four, fibrinogen assay could not be done. Modifications in the ISTH scoring with the exclusion of fibrinogen, i.e. modified ISTH (MI) score and subsequent inclusion of schistocytes, i.e. modified ISTH with schistocytes (MIS) score, were used. The modified scores were analyzed for diagnostic accuracy parameters and agreement with ISTH score.
RESULTS
Amongst 56 cases, 9/52 (17.3%), 22 (39.3%) and 17 (30.4%) were diagnosed as positive for overt DIC by ISTH, MI and MIS scores and mortality was 33, 22.7 and 17.6 per cent, respectively. The sensitivity, specificity, positive and negative predictive values for the MI score were 100, 74.4, 45 and 100 per cent and for MIS score were 100, 86, 60 and 100 per cent, respectively. The agreement between MI score and MIS score with ISTH score was moderate [κ=0.502, 95% confidence interval (CI): 0.272-0.732, P<0.001] and substantial (κ=0.681, 95% CI: 0.45-0.91, P<0.001).
INTERPRETATION & CONCLUSIONS: In the present study, the calculated mortality was highest by ISTH score. Best agreement was between MIS score and ISTH score. In a resource-constrained setup where fibrinogen assay and therefore ISTH score is difficult, it is suggested that MIS score can be considered.
背景与目的
弥散性血管内凝血（DIC）的诊断主要基于临床特征和支持性实验室检查。国际血栓与止血学会（ISTH）提出了一种用于显性 DIC 诊断的评分系统。然而，由于某些情况下存在相关炎症，本应降低的纤维蛋白原值通常会升高。此外，外周血涂片显示裂体细胞，但该指标并未纳入评分系统。本研究旨在评估疑似 DIC 患者中 ISTH 评分系统及其改良版的诊断准确性。
方法
本研究纳入了 56 例患者，其中 4 例无法进行纤维蛋白原检测。排除纤维蛋白原后，对 ISTH 评分进行了改良，即改良 ISTH（MI）评分，并随后纳入了裂体细胞，即改良 ISTH 加裂体细胞（MIS）评分。分析了改良评分的诊断准确性参数和与 ISTH 评分的一致性。
结果
56 例患者中，ISTH、MI 和 MIS 评分分别有 9/52（17.3%）、22/52（39.3%）和 17/52（30.4%）例被诊断为显性 DIC，死亡率分别为 33%、22.7%和 17.6%。MI 评分的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、74.4%、45%和 100%，MIS 评分的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、86%、60%和 100%。MI 评分与 MIS 评分与 ISTH 评分的一致性为中度[κ=0.502，95%置信区间（CI）：0.272-0.732，P<0.001]和高度[κ=0.681，95% CI：0.45-0.91，P<0.001]。
解释与结论
在本研究中，ISTH 评分计算的死亡率最高。MIS 评分与 ISTH 评分的一致性最好。在资源有限的情况下，纤维蛋白原检测和 ISTH 评分较为困难，建议考虑使用 MIS 评分。
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