DIC

July 19th 2002
9:00 to 13:00
Whittier Room
Boston Park Plaza Hotel

Chairman: M. Levi, The Netherlands
Co-chairs:  I. Bokarew, Russia; K. Hoots, USA; N. Sakuragawa, Japan; C-H. Toh, UK;
H. Wada, Japan

The meeting of the DIC subcommittee consisted of three parts: (1) presentations from various research groups on their experience and prospective validation of the scoring system for overt DIC that was accepted by the SSC in 2001, (2) an overview on the use of molecular markers for the diagnosis of DIC, and (3) an update on clinical studies for the treatment of sepsis and DIC.  

In the past year several research groups have used the newly adopted SSC/ISTH scoring system for overt DIC and now report here on their experience.

Cheng-Hock Toh (Liverpool, UK) reported on his experience with the DIC scoring system for both overt and non-overt DIC. His data indicate that the non-overt template is workable. He proposed to prospectively collect data to complete and refine the scoring system for non-overt DIC in particular. Hideo Wada (Mie, Japan) compared the ISTH DIC score with the score for DIC of the Japanese Ministry of Health. He demonstrated a good overall agreement between the two scoring systems, with a somewhat higher sensitivity and lower specificity of the Japanese score, mostly due to the high incidence of a diagnosis of DIC in Japanese cancer patients. Marcel Levi presented two prospective studies from Amsterdam comprising 50 and 217 patients, respectively. In consecutive ICU patients the incidence of DIC was 32%, and the DIC score had a sensitivity of 91% and a specificity of 97%. The score correlated well with molecular markers for DIC. Dilys Rapson (Kingston, Canada) discussed the practical issues of assessing the DIC score in critically ill patients.

In subsequent discussion the need for a collaborative trial to prospectively validate DIC was considered. Such a study could benefit from a standardised ‘gold-standard’ for DIC and eliminate inter-center differences. It was concluded that the subcommittee will organise a multicenter study including tentatively 500-1000 consecutive ICU patients from at least 5 centers world-wide. In the coming year the protocol will be developed and centers can enlist with the subcommittee’s chairman.

The second section of the meeting was devoted to the use of molecular markers in the diagnosis of DIC. Michio Matsuda (Tokyo, Japan) presented an overview on the use of fibrin-related markers, such as D-dimer and soluble fibrin, that play a central role in the scoring system for overt DIC. Their specific role in the scoring system for non-overt DIC will need to be worked out. Gary Kinasewitz (Oklahoma, USA) presented data on the use of the SSC/ISTH scoring system in the succesful Prowess trial of recombinant activated protein C in patients with sepsis.

In the discussion that followed the direction of the development of the non-overt DIC score was discussed. The subcommittee decided that in the coming year this system will be further developed during a working party meeting in December-January and will be discussed during the subcommittee meeting in Birmingham in 2003.

The last part of the meeting consisted of an overview of the most recent clinical studies in patients with sepsis and DIC with anticoagulant factor concentrates. Jorn Dalsgaard Nielsen (Copenhagen, Denmark) reviewed the clinical experience with antithrombin concentrate replacement therapy. Despite the negative phase III clinical trial there might be benefit to be expected of high-dose antithrombin infusion due to its postulated anti-inflammatory effect and when it is not combined with heparin. Jean Francois Dhainaut (Paris, France) highlighted the positive clinical results with recombinant human activated protein C in patients with sepsis. This agent was shown to lower mortality and is actually one of the first therapeutics in sepsis that was shown to be effective. Fletcher Taylor (Oklahoma, USA) focused on the use of recombinant TFPI in sepsis and DIC in preclinical and clinical settings.

The attendance was about 100 people (at some points during the meeting exceeding the number of seats available). There was adequate discussion opportunity during the meeting.