The meeting of the SSC DIC subcommittee consisted of two parts: 1) an overview on recent progress in animal models of DIC and 2) a discussion on the definition of DIC, scoring criteria for overt and non-overt DIC and establishment of a scoring system.

The first part of the meeting consisted of a mini-symposium on animal models of DIC. Dr. Asakura (Japan) discussed differences between endotoxin-induced and tissue factor-induced DIC in rats. Dr. Rijneveld (the Netherlands) presented data on the cross-talk between fibrinolytic proteins and inflammation and infection in transgene mice models. In the paper of Dörfller, Levi and Carmeliet (Switzerland, the Netherlands, Belgium) the hypothesis that subjects with thrombophilia are potentially more vulnerable to severe DIC was supported by observations in mice with a one allel targeted deficiency of protein C. Dr. Taylor (USA) discussed the dynamics of coagulation and inflammatory parameters in his model of sepsis in baboons, clinical and laboratory effects. Lastly, Dr. Jilma (Austria) gave a comprehensive overview of the effect of various anticogulant interventions in models of human endotoxemia.

M. Levi started the discussion in the second part of the meeting by providing an historical overview of the work of this subcommittee to establish a definition of DIC and a diagnostic scoring system. The activities of the special working group between 1999 and the present meeting were summarized. A working group, consisting of 10 active subcommittee members, convened a number of times to discuss a consensual definition of DIC and a practical (diagnostic) scoring system for the syndrome. A small writing committee summarized the results of the discussion in a draft report. This was sent to over 50 experts in Hemostasis/Thrombosis or Critical Care Medicine. More than 30 experts have sent extensive reviews of the draft proposal. The draft proposal consists of a background position statement (one concept and six considerations) followed by a definition of DIC. Along these lines a diagnostic scoring system for overt DIC is proposed. In addition, a template for a scoring system for non-overt DIC is added that can be further developed depending on the specific needs of the user. Dr. Levi demonstrated that, in an initial prospective evaluation and validation of the scoring system for overt DIC, the scoring system was not only feasible in clinical practice but had a 92-98% concordance with the clinical diagnosis of DIC.

Dr. Hoots (USA) summarized the objectives of the subcommitteeís proposal and outlined in detail the scoring system for overt DIC. The scoring system consist of a simple algorhythm, using widely available coagulation tests.

In the general discussion following these presentations some issues were raised by the audience, including the validity of the score for patients that have undergone cardiac surgery or patients with advanced liver disease. These concerns diminished when it was taken into account that patients need to have a classifying diagnosis known to be associated with DIC to enter the scoring system, although liver disease remains a problematic area. Another issue regarded the inclusion of clinical criteria, such as organ failure and bleeding, into the score. At the urge of critical care specialists, these items were left out of the score, since the DIC score is likely to become part of organ failure scores, which is impossible if organ failure itself is part of the DIC score. In the prospective validation of the score, special attention will be given to this matter.

Overall, the subcommitteeís proposal was received with enthusiasm by the audience.

Dr. Levi formally proposed to submit the paper to the SSC, which was unanimously approved. If accepted by the SSC, the paper will be published on the ISTH website and a short version will appear in Thrombosis and Haemostasis.

Lastly, future activities of the subcommittee were discussed. The program of the subcommittee for the next year will consist of (1) a prospective validation of the score for overt DIC in a multicenter clinical trial, (2) a further refinement of the non-overt diagnostic scoring system, and (3) a critical appraisal of animal experimental models for DIC.

The attendance was about 225-250 people. There was adequate discussion opportunity in both parts of the meeting.