Allen Cecily, Heskel Marina, Butt Ayesha, Tormey Christopher, Pine Alexander B, Lee Alfred I, Gautam Samir
Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA,
Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.
Acta Haematol. 2025;148(2):220-225. doi: 10.1159/000540239. Epub 2024 Jul 16.
Distinguishing disseminated intravascular coagulation (DIC) from the coagulopathy of liver disease represents a common clinical challenge. Here, we evaluated the utility of two diagnostic tools frequently used to differentiate between these conditions: factor VIII (FVIII) levels and the International Society on Thrombosis and Hemostasis (ISTH) DIC score.
To this end, we conducted a retrospective chart review of patients with DIC, liver disease, or both. Multiple logistic regression was performed, and receiver operating characteristic curves were generated to calculate the area under curve (AUC) for distinguishing DIC in the setting of liver disease.
Among 123 patients with DIC, liver disease, or liver disease plus DIC, FVIII levels did not differ significantly. ISTH scores were lower in patients with DIC than in liver disease with or without DIC. Addition of several laboratory parameters to the ISTH score, including mean platelet volume, FV, FVIII, international normalized ratio, and activated partial thromboplastin time, improved AUC for distinguishing DIC in liver disease from liver disease alone (AUC = 0.76; p < 0.0001).
We conclude that FVIII levels do not distinguish DIC from liver disease, and ISTH DIC scores are not predictive of DIC in patients with liver disease. Inclusion of additional lab variables within the ISTH DIC score may aid in identifying DIC in patients with liver disease.
区分弥散性血管内凝血（DIC）和肝病导致的凝血病是一项常见的临床挑战。在此，我们评估了两种常用于区分这些病症的诊断工具的效用：凝血因子VIII（FVIII）水平和国际血栓与止血学会（ISTH）DIC评分。
为此，我们对患有DIC、肝病或两者皆有的患者进行了回顾性病历审查。进行了多因素逻辑回归分析，并生成了受试者工作特征曲线以计算在肝病背景下区分DIC的曲线下面积（AUC）。
在123例患有DIC、肝病或肝病合并DIC的患者中，FVIII水平无显著差异。DIC患者的ISTH评分低于患有或未患有DIC的肝病患者。在ISTH评分中加入几个实验室参数，包括平均血小板体积、FV、FVIII、国际标准化比值和活化部分凝血活酶时间，可提高在肝病中区分DIC与单纯肝病的AUC（AUC = 0.76；p < 0.0001）。
我们得出结论，FVIII水平无法区分DIC和肝病，且ISTH DIC评分不能预测肝病患者是否患有DIC。在ISTH DIC评分中纳入其他实验室变量可能有助于识别肝病患者中的DIC。
