The International Society of Thrombosis and Hemostasis (ISTH) criteria in intensive care units

Background

Disseminated Intravascular Coagulation (DIC) has been assessed by the International Society of Thrombosis and Hemostasis (ISTH) 2001 and the ISTH 2018-modified version. More investigations are needed to assess usability and visibility of those DIC scoring systems in the intensive care units (ICU).

Aims

This study investigated the predictive performance of the ISTH–Overt DIC versions of 28–day mortality in ICUs compared to SOFA as a gold standard assessment tool of sepsis.

Methods

A retrospective design (2015–2017) included 220 adult patients enrolled from medical and surgical ICUs in two major hospitals in Jordan. We calculated ISTH–Overt DIC scores and SOFA score on time of DIC diagnosis. Overt DIC was categorized based on a score of ≥ five for ISTH DIC 2001; and ≥ 4 for ISTH DIC 2018. Provided, a score > 12 was categorized as Multiple–Organ– Dysfunction–Syndrome (MODS) for Sequential Organ Failure Assessment (SOFA) score. Then, 28–day mortality follow-up was performed.

Results

More than half of sample died before 28–days of follow–up. The analysis of Receiver Operating Characteristic (ROC) showed that higher scores of ISTH DIC 2001(≥ 5), ISTH DIC 2018 (≥ 4), and SOFA score (>12) were highly associated with 28–day mortality. The ISTH DIC 2001 and SOFA score were superior on the modified ISTH 2018 in predicting 28–day mortality, with an Area Under the Curve (AUC) of (0.724 vs. 0.822 vs. 0.507, respectively). Yet, the accuracy of the SOFA score was better than the ISTH DIC 2001. Conclusion: This study suggests that ISTH DIC 2001 score is helpful when applied on medical and surgical ICU Jordanian populations. It showed better results compared to the Modified ISTH DIC 2018 in mortality prediction, regardless of the underlying diseases.