Screening tests of disseminated intravascular coagulation: Guidelines for rapid and specific laboratory diagnosis

Objective: To study the clinician's ordering pattern in the diagnosis of di sseminated intravascular coagulation (DIC) and to analyze the utility of se lected tests by assessing their sensitivity, specificity, and overall effic iency. Design: Retrospective, nonrandomized, clinical study. Setting: University hospital intensive care units. Patients: A total of 82 inpatients treated in our intensive care units were identified from the hospital computer system as having been tested for Die in a I-month period. Intervention: Screening tests for DIG were ordered for the suspected patien ts. Measurements and Main Results:Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen/fibrin degradation products (FDP), and fibrinogen w ere used most frequently as DIC diagnostic tests. The FDP and D-dimer combi nation (n = 39) had the highest diagnostic efficiency of 95%, with sensitiv ity being 91% and specificity 94%. This is followed by FDP (n = 71), effici ency 87%, sensitivity 100%, and specificity 67%; PT/PTT and FDP combination (n = 71), efficiency 86%, sensitivity 91%, and specificity 71%; and D-dime r (0 = 44), efficiency 80%, sensitivity 91%, and specificity 68%. The rest of the commonly used tests, such as PT, PTT, thrombin time, platelet count, fibrinogen, and the presence of schistocytes (n = 80), had individually ei ther low specificity or low sensitivity and, therefore, low efficiency scor es (57%, 57%, 70%, 67%, 65%, and 51%, respectively). Conclusions: The D-dimer and FDP tests offered the best test panel in the d iagnosis of Die. We propose the use of D-dimer, FDP, and antithrombin as th e DIG diagnostic test panel, with D-dimer and FDP providing a rapid and spe cific diagnosis, antithrombin providing insight to the severity and prognos is, and FDP (rapid and less expensive than D-dimer) to follow-up the progre ss of the condition once the diagnosis is established.