Disseminated Intravascular Coagulation (DIC)

31 June 2006
Oslo Kongressenter, Norway

The session was broadly divided into 3 strands:

1. Laboratory standardization issues in DIC.

Nigel Key discussed the current situation on microparticle estimation. The majority of laboratories use flow cytometry with the others using ELISA capturing for phosphatidylserine or the target antigen of interest. There are issues around freeze thawing that need to be addressed and this is a potential joint endeavour between this SSC and the Working Group on Vascular Biology. Quality and specificity of antibodies are also a consideration in terms of determining tissue factor specificity.

Carl-Erik Dempfle concentrated on the issues surrounding accurate determination of high Ddimer levels. This is particularly relevant in the refinement of the DIC scoring systems that depends on meaningful cut-off levels of D-dimer. Work is underway on a common calibrator of the Ddimer assay with results anticipated by the end of the year. This also requires follow-on studies evaluating individual performances of each assay in clinical studies to allow for refinement. However, this work should not delay the recommendation of the current DIC algorithms.

With increasing number of publications confirming the utility of the biphasic waveform in DIC and sepsis, Tina Dutt and Colin Downey discussed the standardization work in this area. When using the MDA180 analyser and MDA reagents, there was good correlation with a CV of 0.23.

Elaine Gray discussed the laboratory assays of protein C and antithrombin in the DIC setting. Chromogenic assays appear appropriate but care is needed with choice of reagent blanks. PC deficient plasma as sample diluent gives higher results than when diluted in buffer.

2. The role of inflammatory markers in DIC testing.

Hideo Wada discussed the growing literature on high mobility group box proteins in sepsis/DIC. The highest HMGBI levels were in patients with organ failure and non-survivors. HMGB1 plasma levels correlated with the DIC score and sepsis-related organ failure assessment (SOFA) score.

Hyun Kyung Kim investigated the prognostic value of a new parameter (the fibrinogen/CRP ratio) for predicting 28-day mortality in 1056 patients with suspected DIC and found that the area under the ROC curve of the fibrinogen/CRP ratio, for predicting 28-day mortality, showed significantly better discriminative power than did that of the fibrinogen level.

Jorn Nielsen overviewed the state of understanding on inflammatory markers in DIC. At present, he concluded that measuring soluble adhesion markers would not add to prognostication but might be helpful in pathogenic understanding.

3. Subcommittee Communication and way forward.

Discussions led by Keith Hoots and Fletcher Taylor met with a lively response, with broad agreement that we are ready to submit a communication for publication to recommend use of both overt and non-overt algorithms. We will also look at the evolution of the overt scoring system by incorporating useful elements from the non-overt parameters. In addition, the emphasis will be in applying scoring longitudinally and how that might be incorporated into management issues.