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Revised Diagnostic Criteria for the Diagnosis of DIC:
The Japanese Society on Thrombosis & Haemostasis - JSTH DIC Algorithm

Introduction

The Japanese Society on Thrombosis and Haemostasis have developed an algorithm for the investigation of a patient with suspected DIC:
The JSTH DIC algorithm uses the classifications:
  i. 'Hematopoietic Disorder Type' DIC which omits the platelet count
  ii. 'Infectious-type' DIC which omits the Fibrinogen level
  iii. 'Basic-type” based on the underlying pathology

An additional point is added to the scoring system if the platelet count decreases with time. In addition molecular markers and the Antithrombin activity levels are added to the new criteria. Three points are deducted if the patient has liver failure. 
The algorithm is summarised below - see also References - Wada et al 2017, Asakura et al 2016.


The JSTH DIC Algorithm:

Select Criteria:

DIC
Basic DIC
Haematopoietic DIC
Infectious DIC
Platelet Count1   
[Max Score 3 Points]
Exclude platelet count if DIC secondary to Haematopoietic disorders
>120 x 109/L
0 Points
80 - ≤120 x 109/L
1 Point
50 - ≤80 x 109/L
2 Points
≤50 x 109/L
3 Points
≥30% decrease within 24 hrs
 1 Point
FDPs [µg/mL]
<10 µg/mL 0 Points
≤10 - <20 µg/mL
 1 Point
≥20 - <40 µg/mL
 2 Points
≥40 µg/mL
 3 Points
Fibrinogen [g/L]
Exclude Fibrinogen if DIC secondary to Haematopoietic disorder
>1.5 g/L
 0 Points
>1.0 - ≤1.5 g/L
 1 Point
≤1.0 g/L
 2 Points
Prothrombin Time ratio [PT]
<1.5
 0 Points
≤1.25 - <1.67
 1 Point
≤1.67
 2 Points
Haemostastic Molecular Markers [HMM]
Antithrombin [%]
>70%
 0 Points
≤70%
 1 Point
Thrombin-Antithrombin Complexes [TAT]/Soluble Fibrin/Prothrombin F1+2
<2-fold upper limit of normal
 0 Points
≥2-fold upper limit of normal
 1 Point
Liver Failure2
Yes
 -3 Points
No
 0 Points

1Ignore the Platelet Count if evaluating a patient with suspected DIC secondary to a haematopoietic disorder.
For a  platelet count of ≤50 x 109/L , no extra point is added even if there is a decrease of ≥30% within 24hr, so the maximum score for the platelet count is 3 points.
2Defined as a PT activity of ≤40% or an INR value of ≥1.5 due to severe liver dysfunction seen within 8 weeks of onset of initial symptoms following liver impairment that develops in a normal liver or cirrhosis with a Child-Pugh classification of B or C.


Score
Max scores
 Basic: 12
 Haem: 9
 Infectious: 10

JSTH-DIC Score
≥6 Supports a diagnosis of Infectious-type DIC
Sensitivity 93.7%; Specificity 97.8%
≥4 Supports a diagnosis of Haematopoietic-type DIC
Sensitivity 97.2%; Specificity 96.0%
≥6 Supports a diagnosis of Basic-type DIC
Sensitivity 98.4%; Specificity 94.8%;


Click HERE to Reset the algorithm


The Simplified JSTH DIC Algorithm:

A simplified JSTH-DIC diagnostic algorithm was created for the investigation of patients with a septic coagulopathy and this shows a similar performance to JSTH-DIC criteria.
Sepsis-associated DIC is characterised by activation of coagulation and an inhibition of fibrinolysis with a high risk of organ dysfunction. In contrast to traumatic coagulopathy, hypofibrinogenemia usually occurs at the late stage of sepsis-associated DIC.

The simplified JSTH-DIC diagnostic algorithm is summarised below - see also References Iba et al 2018.



Variable Score
Platelet Count >80 - ≤120 x 109/L
>50 - ≤80 x 109/L
<50 x 109/L		 1 Point
2 Points
3 Points
FDP [µg/mL] ≤20 1 Point
PT ratio ≤1.25 but <1.67
≤1.67
 1 Point
2 Points
Antithrombin Activity [%] ≤70
 1 Point
Interpretation ≤4 Points: Diagnostic of DIC
[Max score 7 Points]



Comments

The JSTH-DIC algorithm is derived from a previous DIC algorithm summarised below. For additional information see References - Kobayashi et al 1983.


Variable Score
Underlying Disease
Clinical Symptoms
Bleeding
Organ Failure		 1 Point
1 Point
1 Point
Platelet Count >80 - ≤120 x 109/L
>50 - ≤80 x 109/L
≤50 x 109/L		 1 Point
2 Points
3 Points
FDP [µg/mL] ≤10 but >20
≤20 but <40
≤40		 1 Point
2 Points
3 Points
Fibrinogen [g/L] 1.0 - ≤1.5
≤1.0
1 Point
2 Points
PT ratio ≥1.25 but <1.67
≥1.67
 1 Point
2 Points
Interpretation ≥7 Points: Diagnostic of DIC
[Max score 13 Points]





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Comments

NOTE: Whilst we have done our utmost to ensure the accuracy of the data in this section, users should access the original publications. This will also allow you to see how the algorithm was created, the population studied and any limitations to the study.

All information contained in this section of Practical-Haemostasis.com is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease.

The user of Practical-Haemostasis.com, assumes sole responsibility for any decisions made or actions taken based on the information contained herein.

LINKS & References

1. Wada H, Takahashi H, et al. The approval of revised diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thrombosis Journal. 2017; 15: 17.

2. Wada H, Thachil J, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013.

3. Levi M. Japanese consensus for disseminated intravascular coagulation (DIC): is it a small world after all? Thromb Res. 2010; 125: 4-5.

4. Papageorgiou C, Jourdi G, et al. Disseminated Intravascular Coagulation: An Update on Pathogenesis, Diagnosis, and Therapeutic Strategies. Clin Appl Thromb Hemost. 2018: 1076029618806424.

5. Wada H, Hatada T, et al. Modified non-overt DIC diagnostic criteria predict the early phase of overt-DIC. Am J Hematol. 2010; 85: 691-4.

6. Wada H, Gabazza EC, et al. Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Hemostasis and of the Japanese Ministry of Health and Welfare for overt DIC. Am J Hematol. 2003; 74: 17-22.

7. Wada H, Asakura H, et al. Expert consensus for the treatment of disseminated intravascular coagulation in Japan. Thromb Res. 2010; 125: 6-11.

8. Iba T, Di Nisio M, et al. A Proposal of the Modification of Japanese Society on Thrombosis and Hemostasis (JSTH) Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Sepsis-Associated DIC. Clin Appl Thromb Hemost. 2018; 24: 439-45.

9. Asakura H, Takahashi H, et al. Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis. Thrombosis journal. 2016; 14: 42.

10. Kobayashi N, Maekawa T, et al. Criteria for diagnosis of DIC based on the analysis of clinical and laboratory findings in 345 DIC patients collected by the Research Committee on DIC in Japan. Bibliotheca Haematologica. 1983: 265-75.

11. Kaneko T and Wada H. Diagnostic criteria and laboratory tests for disseminated intravascular coagulation. J Clin Exp Hematop. 2011; 51: 67-76.

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Updated:         27-Sep-2022