Prospective comparison of new Japanese Association for Acute Medicine (JAAM) DIC and International Society of Thrombosis and Hemostasis (ISTH) DIC score in critically ill septic patients

• Published in: Thrombosis research 2012-04, Vol.129 (4), p.e119-e125
• Main Authors: Singh, R.K, Baronia, A.K, Sahoo, J.N, Sharma, Seema, Naval, Ram, Pandey, C.M, Poddar, Banani, Azim, Afzal, Gurjar, Mohan
• Format: Article
• Language: English
• Subjects: Acute Physiology And Chronic Health Evaluation; Adult; Aged; Aged, 80 and over; Critical Illness; Disseminated intravascular coagulation; Disseminated Intravascular Coagulation - blood; Disseminated Intravascular Coagulation - diagnosis; Disseminated Intravascular Coagulation - etiology; Female; Hematology, Oncology and Palliative Medicine; Humans; International Society of Thrombosis and Hemostasis; Japan; Japanese Association for Acute Medicine; Male; Middle Aged; Prospective Studies; Sepsis; Sepsis - blood; Sepsis - complications; Sepsis - diagnosis; Sequential Organ Failure Assessment; Severity of Illness Index; Young Adult
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2011.11.017

Abstract Introduction We prospectively compared the new Japanese Association for Acute Medicine (JAAM) score with the International Society of Thrombosis and Hemostasis (ISTH) score for diagnosis of disseminated intravascular coagulation (DIC) in septic patients admitted in a general critical care intensive care unit. Material and method Septic patients with platelet count of < 150 × 109 /L were included. Both DIC scores were estimated from day 1 to day 4 along with APACHE II and SOFA scores. Results Out of the 148 blood samples drawn from 42 patients (28 male & 14 female) the JAAM and ISTH DIC scores had an overall significant agreement (k = 0.246, p < 0.001) in 83 samples. JAAM score had higher diagnostic rates on all four days. Significant (p ≤ 0.001) day wise variation existed in JAAM and ISTH DIC scores. Correlation between JAAM DIC and ISTH DIC scores on day 1 (r = 0.631) & day 4 (r = 0.609) was significant (p < 0.001). Pneumonia was the predominant cause of sepsis. Twenty seven (64.3%) patients died during their stay in ICU. Amongst DIC patients both severity scores (SOFA/APACHE II) and DIC scores (JAAM/ISTH) did not discriminate between survivors and non-survivors. Health care associated infection (p = 0.040), high lactate levels (p = 0.020) on day 1 and high procalcitonin levels (p = 0.036) were found to have significant discriminating ability between survivors and non-survivors. Significantly shorter length of stay was observed amongst non-survivors (p = 0.002). Conclusions In sepsis the JAAM DIC score identified most of the patients diagnosed by the overt ISTH criteria, but failed to discriminate between survivors and non-survivors amongst DIC patients.