Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

被引：52

作者：

Asakura H. ^{[1
]}

Takahashi H. ^{[2
]}

Uchiyama T. ^{[3
]}

Eguchi Y. ^{[4
]}

Okamoto K. ^{[5
]}

Kawasugi K. ^{[6
]}

Madoiwa S. ^{[7
]}

Wada H. ^{[8
]}

机构：

[1] Kanazawa University School of Medicine, Department of Internal Medicine (III), 13-1, Takaramachi, Kanazawa

[2] Niigata Prefectural Kamo Hospital, Department of Internal Medicine, 1-9-1 Aomicho, Kamo, Niigata

[3] National Hospital Organization Takasaki General Medical Center, Department of Laboratory Medicine, 36 Takamatsu-Cho, Takasaki, Gunma

[4] Shiga University of Medical Science, Department of Critical and Intensive Care Medicine, Seta Tsukinowa-cho, Otsu, Shiga

[5] Kitakyushu City Yahata Hospital, Gastroenterology and Hepatology Center, 4-18-1, Nishihon-machi, Yahatahigashi-ku, Kitakyushu, Fukuoka

[6] Teikyo University School of Medicine, Department of Hematology, 2-11-1 Kaga Itabashi-Ku, Tokyo

[7] Tokyo Saiseikai Central Hospital, Department of Clinical and Laboratory Medicine, 1-4-17, Mita, Minato-ku, Tokyo

[8] Mie University Graduate School of Medicine, Department of Molecular and Laboratory Medicine, Tsu, Mie

来源：

Thrombosis Journal | / 14卷 / 1期

基金：

日本学术振兴会;

关键词：

Diagnostic criteria; DIC; Disseminated intravascular coagulation; Enhanced-fibrinolytic-type DIC; Suppressed-fibrinolytic-type DIC;

D O I：

10.1186/s12959-016-0117-x

中图分类号：

学科分类号：

摘要：

Disseminated intravascular coagulation (DIC) is a serious disease that, in the presence of underlying disease, causes persistent, generalized, marked coagulation activation. Early treatment based on an appropriate diagnosis is very important for improving patients' prognosis, to which end diagnostic criteria play a key role. Several criteria have been proposed, but each has its strengths and weaknesses, and improved criteria are needed. Widespread use of coagulofibrinolytic markers has elucidated that the pathology of DIC differs greatly as a function of the underlying disease. Thus, discriminating use of DIC diagnostic criteria that take underlying diseases into account is important. DIC diagnostic criteria that are well known in Japan include the Japanese Ministry of Health and Welfare's old DIC diagnostic criteria (JMHW criteria), the International Society on Thrombosis and Haemostasis's DIC diagnostic criteria (ISTH criteria), and the Japanese Association for Acute Medicine's acute-stage DIC diagnostic criteria (JAAM criteria). Those criteria have their respective drawbacks: the sensitivity of the ISTH criteria is poor, the JAAM criteria cannot be applied to all underlying diseases, and the JMHW criteria have poor sensitivity in the case of infections, do not use molecular markers, and result in misdiagnosis. The Japanese Society on Thrombosis and Hemostasis's newly proposed provisional draft DIC diagnostic criteria (new criteria) use diagnostic criteria classifications of "hematopoietic disorder type", "infectious type", and "basic type" based on the underlying pathology. For the hematopoietic disorder type the platelet count is omitted from the score, while for the infectious type, fibrinogen is omitted from the score. Also, points are added if the platelet count decreases with time. In the new criteria, molecular markers and antithrombin activity have been newly included, and as a countermeasure for misdiagnosis, 3 points are deducted if there is liver failure. In this paper, we discuss various problems encountered with DIC diagnosis, and we describe the new criteria together with the events that led to their creation. These new diagnostic criteria take into account the underlying diseases of wide area, and we expect that they will serve clinicians well due to the above adaptations and improvements. © 2016 The Author(s).

引用

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