Original article / research
Year : 2026 Month : July Volume : 15 Issue : 3 Page : PO18 - PO23 Full Version

Evaluating Scoring Systems and Biomarkers for Disseminated Intravascular Coagulation in Critically Ill Patients: A Prospective Cohort Study
Siddharth Sagar, Anjali J Kelkar, Vaishali Patil, Harshal Patil
1. Senior Resident, Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India. 2. Director Laboratory Services and Head, Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India. 3. Consultant Pathologist, Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India. 4. Consultant Pathologist, Department of Pathology, Ruby Hall Clinic, Pune, Maharashtra, India.
 
Correspondence Address :
Anjali J Kelkar,
11/3B1, New Ajantha Avenue, Off Paud Road, Near Krishna Hospital Kothrud,
Pune, Maharashtra, India.
E-mail: kelkar.anjali.jaydeep@gmail.com
 
ABSTRACT
: Introduction: Disseminated Intravascular Coagulation (DIC) is a critical haemostatic disorder marked by systemic activation of coagulation, leading to microvascular thrombosis, consumption of clotting factors, and bleeding. Multiple diagnostic criteria exist however, no universally accepted gold standard is available, and their comparative performance varies across clinical settings.

Aim: To evaluate and compare the diagnostic performance of four DIC scoring systems the International Society on Thrombosis and Haemostasis (ISTH), Japanese Association for Acute Medicine (JAAM), Japanese Ministry of Health and Welfare (JMHW), and Korean Society on Thrombosis and Haemostasis (KSTH) in critically ill patients.

Materials and Methods: The present prospective cohort study was conducted in the Intensive Care Units (ICUs) of a superspeciality teaching hospital in Pune, Maharashtra, India, from 1 June 2023 to 29 February 2024. Thirty-five consecutive adults with clinical suspicion of DIC were enrolled. Baseline haemostatic parameters including platelet count, Prothrombin Time (PT), Activated Partial Thromboplastin Time (aPTT), fibrinogen, D-dimer, Red Cell Distribution Width (RDW), and Antithrombin III (ATIII) activity-were measured at admission. Overt DIC was defined according to the ISTH criteria (score ≥5). The diagnostic performance of the JAAM, JMHW, and KSTH scoring systems was evaluated using ISTH as the reference standard. Statistical analyses included descriptive statistics, independent t-test or Mann-Whitney U-test for continuous variables, Chi-square or Fisher’s exact test for categorical variables, and Receiver Operating Characteristic (ROC) curve analysis with calculation of Area Under the Curve (AUC). Correlations between scoring systems and laboratory parameters were assessed using Pearson’s correlation coefficient. All analyses were performed using IBM Statistical Package for Social Sciences (SPSS) Statistics version 25.0 (IBM Corp., Armonk, NY, USA), with p <0.05 considered statistically significant.

Results: Overt DIC was identified in 22 of 35 patients (62.9%), and overall mortality was 28.5% (10/35). Patients demonstrated prolonged PT (19.2±4.8s), elevated aPTT (42.5±9.2s) and D-dimer levels (2,480±1,050 ng/mL), reduced fibrinogen (168±74 mg/dL), and low ATIII activity (62±14%). Diagnostic accuracy relative to ISTH was highest for JAAM (AUC 0.80; 95% Confidence Intervals (CI) 0.65-0.93) and KSTH (AUC 0.76; 95% CI 0.61-0.90), while JMHW showed lower performance (AUC 0.72; 95% CI 0.56-0.87). Correlations with ISTH scores were as follows: platelet count r=-0.48 (p=0.009), PT r=0.52 (p=0.004), D-dimer r=0.45 (p=0.012), and ATIII activity r=-0.43 (p=0.010). RDW showed a weak, non-significant association with ISTH score (r=0.18, p=0.301).

Conclusion: The ISTH scoring system demonstrated the strongest diagnostic reliability for DIC, while JAAM and KSTH provided comparable sensitivity. Conventional coagulation markers and ATIII activity correlated well with disease severity, supporting their routine diagnostic utility. RDW showed limited discriminative and prognostic value.
Keywords : Haemostatic disorder, International society on thrombosis and haemostatis, Microvascular thrombosis
DOI and Others : DOI: 10.7860/NJLM/2026/84445.2978 Date of Submission: Sep 19, 2025 Date of Peer Review: Nov 03, 2025 Date of Acceptance: Dec 19, 2025 Date of Publishing: Jul 01, 2026 AUTHOR DECLARATION: • Financial or Other Competing Interests: None • Was Ethics Committee Approval obtained for this study? Yes • Was informed consent obtained from the subjects involved in the study? NA • For any images presented appropriate consent has been obtained from the subjects. NA PLAGIARISM CHECKING METHODS: • Plagiarism X-checker: Oct 19, 2025 • Manual Googling: Dec 12, 2025 • iThenticate Software: Dec 18, 2025 (7%) ETYMOLOGY: Author Origin EMENDATIONS: 7
 
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