Mori Hirotaka, Harada-Shirado Kayo, Kawano Noriaki, Hayakawa Mineji, Seki Yoshinobu, Uchiyama Toshimasa, Yamakawa Kazuma, Ishikura Hiroyasu, Irie Yuhei, Nishio Kenji, Yada Noritaka, Okamoto Kohji, Ikezoe Takayuki
Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Fukushima, Japan.
Department of Hematology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kita Takamatsu- machi, Miyazaki, 880-8510, Miyazaki, Japan.
Thromb J. 2023 Aug 7;21(1):84. doi: 10.1186/s12959-023-00523-1.
We compared the prognostic value of the Japanese Society on Thrombosis and Hemostasis (JSTH) disseminated intravascular coagulation (DIC) diagnostic criteria with that of the International Society on Thrombosis and Haemostasis (ISTH) DIC diagnostic criteria for 28-day in-hospital mortality.
We conducted a multicenter prospective cohort study involving two hematology departments, four emergency departments, and one general medicine department in Japan between August 2017 and July 2021. We assessed three ISTH DIC diagnostic criteria categories using low cutoff levels of D-dimer (low D-dimer), high cutoff levels of D-dimer (high D-dimer), and fibrinogen/fibrin degradation products (FDP) as fibrin-related markers. The main outcome was diagnosis-based category additive net reclassification index (NRI).
A total of 222 patients were included: 82 with hematopoietic disorders, 86 with infections, and 54 with other diseases. The 28-day in-hospital mortality rate was 14% (n = 31). The DIC rates diagnosed by the JSTH, ISTH-low D-dimer, high D-dimer, and FDP DIC diagnosis were 52.7%, 47.3%, 42.8%, and 27.0%, respectively. The overall category additive NRI by JSTH DIC diagnosis vs. ISTH-low D-dimer, high D-dimer, and FDP DIC diagnosis were - 10 (95% confidence interval [CI]: -28 to 8, p = 0.282), - 7.8 (95% CI: -26 to 10, p = 0.401), and - 11 (95% CI: -26 to 3, p = 0.131), respectively.
JSTH criterion showed the highest sensitivity for DIC diagnosis that did not improve but reflected the same prognostic value for mortality evaluated using ISTH DIC diagnosis criteria. This finding may help clinicians to use JSTH DIC criterion as an early intervention strategy in patients with coagulopathy.
我们比较了日本血栓与止血学会（JSTH）弥散性血管内凝血（DIC）诊断标准与国际血栓与止血学会（ISTH）DIC诊断标准对28天院内死亡率的预后价值。
2017年8月至2021年7月期间，我们在日本的两个血液科、四个急诊科和一个普通内科开展了一项多中心前瞻性队列研究。我们使用低D-二聚体临界值（低D-二聚体）、高D-二聚体临界值（高D-二聚体）以及纤维蛋白原/纤维蛋白降解产物（FDP）作为纤维蛋白相关标志物，评估了三种ISTH DIC诊断标准类别。主要结局是基于诊断的类别相加净重新分类指数（NRI）。
共纳入222例患者：82例患有造血系统疾病，86例患有感染，54例患有其他疾病。28天院内死亡率为14%（n = 31）。JSTH、ISTH-低D-二聚体、高D-二聚体和FDP DIC诊断所诊断出的DIC发生率分别为52.7%、47.3%、42.8%和27.0%。JSTH DIC诊断与ISTH-低D-二聚体、高D-二聚体和FDP DIC诊断相比，总体类别相加NRI分别为-10（95%置信区间[CI]：-28至8，p = 0.282）、-7.8（95%CI：-26至10，p = 0.401）和-11（95%CI：-26至3，p = 0.131）。
JSTH标准对DIC诊断显示出最高的敏感性，其并未改善但反映出与使用ISTH DIC诊断标准评估的死亡率相同的预后价值。这一发现可能有助于临床医生将JSTH DIC标准用作凝血病患者的早期干预策略。
