Analysis of D-dimer cut-off values for overt DIC diagnosis in exertional heat illness

Abstract

The International Society on Thrombosis and Haemostasis (ISTH) scoring system has been used for diagnosing overt disseminated intravascular coagulation (DIC). However, the cut-off points of fibrin-related markers remain unclear. The ability of the ISTH DIC score and Multiple Organ Dysfunction (MODS) score to predict mortality in cases of exertional heat illness (EHI) was tested. In the process, 3 different D-dimer cut-off values for diagnosing overt DIC were evaluated. Data were obtained on the first day of hospitalization for 76 patients with EHI. The DIC score was calculated according to the ISTH scoring system using 3 D-dimer cut-off values. In predicting mortality, methods 1 and 2 had the same sensitivity and specificity, which were 85% and 73.2%, respectively. The sensitivity for method 3 was 70%. Furthermore, the specificity of the DIC score for method 3 was 89%, which was higher than that of the other 2 methods. The correlation coefficients of the DIC and MODS scores of these 3 methods were 0.757, 0.748, and 0.756, respectively. For the prediction ofmortality, the area under the receiver operating characteristic (ROC) curve for the DIC scores of these 3 methods was 0.838, 0.842, and 0.85, respectively. Furthermore, the area under the ROC curve of the MODS score was 0.927. The DIC score had a certain predictive power of a poor outcome of EHI patients, but this was not better than the MODS score. The present data may serve as a reference in selecting the appropriate D-dimer cut-off point for the ISTH DIC score. Abbreviations: APACHE II = Acute Physiology and Chronic Health Evaluation II, CK = Creatine Kinase, Cr = creatinine, DIC = disseminated intravascular coagulation, EHI = exertional heat illness, EHS = exertional heat stroke, FDPs = fibrinogen degradation products, FIB = fibrinogen, FRMs = fibrin-related marker, GCS = Glasgow Coma Scales, ISTH = International Society on Thrombosis and Haemostasis, MODS = Multiple Organ Dysfunction, NPV = negative predictive value, PLT = platelets, PPV = positive predictive value, PT = prothrombin time, ROC = receiver operating characteristic, ROC = receiver operating characteristic, SOFA = Sepsis- Related Organ Failure, TBil = total bilirubin, WBC = leukocyte.