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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 Count  
[Max Score 3 Points]
Exclude platelet count if DIC secondary to   Haematopoietic disorder
>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]