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A Practical Guide to Haemostasis

ISTH DIC Scoring Algorithm

Introduction:

The ISTH Overt DIC Scoring algorithm was developed by the SSC committee on DIC and published in 2001. This algorithm is only appropriate for use in patients with an underlying disorder that is known to be associated with DIC.  Such disorders include: sepsis, malignancy, trauma, obstetric complications, various vascular malformations, severe immunological reactions, heat stroke and following cardio-pulmonary resuscitation.

The ISTH Overt DIC Score:


Select Criteria:

Platelet Count
>100 x 109/L 0 Points
>50 - <100 x 109/L 1 Point
<50 x 109/L 2 Points
Increase in Fibrin-related Markers [D Dimers]
No change 0 Points
Moderate rise 2 Points
Strong rise 3 Points
Prothrombin Time [PT] Prolongation
3 s or less 0 Points
>3 s but <6 s 1 Point
>6 s 2 Points
Fibrinogen [Clauss] Level
>1.0 g/L 0 Points
<1.0 g/L 1 Point


Score

[Max score 8 points]

Interpretation of Score
< 5 Suggestive of non-overt/low grade DIC. 
Repeat in 1-2 days.
≥ 5 Laboratory evidence consistent with overt DIC. 
Repeat score daily


Click HERE to Reset



Comments:

A Clinical and Laboratory scoring system for non-overt DIC has been developed - see References Toh et al 2005.


Modifications of the ISTH DIC Score

A modification of the ISTH DIC Score in which Fibrinogen is removed from the algorithm has been published. See References Ding et al 2018 for further information.

Click HERE to access the modified ISTH DIC Score.


The ISTH DIC Score
Modifications for use in Pregnancy


DIC is a recognised cause of maternal mortality and a modification of the ISTH DIC Scoring algorithm was developed for use in pregnancy. The modifications are necessary due to the changes in haemostasis that occur in normal pregnancy. The use of three components of the ISTH DIC score - Platelet count, Fibrinogen and differences in PT [compared to a normal laboratory control] allowed the development of an algorithm with a sensitivity of 88% and a specificity of 96% for the diagnosis of DIC. D-dimers were excluded as the levels rise in pregnancy and substantially after 20 weeks in pregnancy.

Click HERE to access the modified ISTH DIC score for use in pregnancy.



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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. Taylor FB, Jr., Toh CH, et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001; 86: 1327-30.

2. Toh CH, Hoots WK, et al. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5-year overview. J Thromb Haemost. 2007; 5: 604-6.

3. Toh CH and Downey C. Performance and prognostic importance of a new clinical and laboratory scoring system for identifying non-overt disseminated intravascular coagulation. Blood coagulation & Fibrinolysis. 2005; 16: 69-74.

4. Toh CH, Alhamdi Y, et al. Current Pathological and Laboratory Considerations in the Diagnosis of Disseminated Intravascular Coagulation. Annals of Laboratory Medicine. 2016; 36: 505-12.

4. 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.

5. Iba T, Levy JH, et al. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Thromb Haemost. 2019; 17: 1989-94.

6. Ding R, Wang Z, et al. Comparison of a new criteria for sepsis-induced coagulopathy and International Society on Thrombosis and Haemostasis disseminated intravascular coagulation score in critically ill patients with sepsis 3.0: a retrospective study. Blood Coagulation & Fibrinolysis 2018; 29: 551-8.

7. Frank CS, Larsen JB. Prognostic Impact of the International Society on Thrombosis and Hemostasis Disseminated Intravascular Coagulation Score in Sepsis: A Systematic Review. Semin Thromb Hemost. 2023.

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Updated:         03-Feb-2023