ISTH Modified DIC Score

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The Modified 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 Modified ISTH DIC score is very similar but removes Fibrinogen from the algorithm - see below:

The Modified ISTH 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

Score

[Max score 6 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

Comments:

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

See also the ISTH 'Sepsis-Induced Coagulopathy [SIC] algorithm.

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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.