Disseminated Intravascular Coagulation: Likelihood Ratios

Introduction: None written.

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Septicemia	30%	similar in gram positive and gram negative sepsis Thromb Haemost. 1999 Aug;82(2):695-705. PMID: 10605770
Trauma	50%	Thromb Haemost. 1999 Aug;82(2):695-705. PMID: 10605770
Acute Leukemia	15%	Thromb Haemost. 1999 Aug;82(2):695-705. PMID: 10605770
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The likelihood ratios of findings for Disseminated Intravascular Coagulation are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

ISTH Criteria

30.3

0.1

Score

*Platelet count (>100 × 109/L = 0, <100 × 109/L = 1, <50 × 109/L = 2)

*Elevated fibrin-related marker (e.g., fibrin degradation products or D-dimer) (no increase, 0; moderate increase, 2; strong increase, 3)[a]

*Prolonged prothrombin time (<3 secs = 0, >3 but <6 secs = 1, >6 secs = 2)

*Fibrinogen level (>1.0 g/L = 0, <1.0 g/L = 1)

[a In most prospective validation studies, D-dimer assays were used and a value above the upper limit of normal (0.4 mcg/L) was considered moderately elevated, whereas a value >10 times the upper limit of normal (4.0 mcg/L) was considered as a strong increase.]

Calculate score

If >=5: compatible with overt DIC

If <5: no overt DIC; repeat next 1–2 days

Study: Crit Care Med. 2004 Dec;32(12):2416-21. PMID: 15599145

Poorly Diagnostic Findings

Finding	+LR	-LR	Comments, Study
Elevated D-dimer	Sensitivity = 93%		specificity not assessed, generally regarded as LOW. Study: Semin Thromb Hemost. 1996;22(1):69-88. PMID: 8711492
Schistocytes	Sensitivity = 50%		irregularly shaped RBCs on blood smear, demonstrating evidence of microangiopathy (i.e. clots in small vessels) specificity not assessed. Study: Semin Thromb Hemost. 1996;22(1):69-88. PMID: 8711492
Prolonged PT	Sensitivity = 50%		specificity not assessed Study: Semin Thromb Hemost. 1996;22(1):69-88. PMID: 8711492
Prolonged PTT	Sensitivity = 50%		specificity not assessed Study: Semin Thromb Hemost. 1996;22(1):69-88. PMID: 8711492
Decreased Fibrinogen	Sensitivity = 28%		specificity not assessed. Study: Thromb Haemost. 1999 Aug;82(2):695-705. PMID: 10605770