Regular Article Prospective comparison of new Japanese Association for Acute Medicine (JAAM) DIC and International Society of Thrombosis and Hemostasis (ISTH) DIC score in critically ill septic patients R.K. Singh a, ⁎, A.K. Baronia a , J.N. Sahoo a , Seema Sharma b , Ram Naval b , C.M. Pandey c , Banani Poddar a , Afzal Azim a , Mohan Gurjar a a Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India b Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India c Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow-226014, India abstract article info Article history: Received 26 August 2011 Received in revised form 4 November 2011 Accepted 9 November 2011 Available online 3 December 2011 Keywords: Disseminated intravascular coagulation Sepsis International Society of Thrombosis and Hemostasis Japanese Association for Acute Medicine Acute Physiology And Chronic Health Evaluation Sequential Organ Failure Assessment Introduction: We prospectively compared the new Japanese Association for Acute Medicine (JAAM) score with the International Society of Thrombosis and Hemostasis (ISTH) score for diagnosis of disseminated in- travascular coagulation (DIC) in septic patients admitted in a general critical care intensive care unit. Material and method: Septic patients with platelet count of b 150 × 10 9 /L were included. Both DIC scores were estimated from day 1 to day 4 along with APACHE II and SOFA scores. Results: Out of the 148 blood samples drawn from 42 patients (28 male & 14 female) the JAAM and ISTH DIC scores had an overall significant agreement (k = 0.246, p b 0.001) in 83 samples. JAAM score had higher diag- nostic rates on all four days. Significant (p ≤ 0.001) day wise variation existed in JAAM and ISTH DIC scores. Correlation between JAAM DIC and ISTH DIC scores on day 1 (r = 0.631) & day 4 (r = 0.609) was significant (p b 0.001). Pneumonia was the predominant cause of sepsis. Twenty seven (64.3%) patients died during their stay in ICU. Amongst DIC patients both severity scores (SOFA/APACHE II) and DIC scores (JAAM/ISTH) did not discriminate between survivors and non-survivors. Health care associated infection (p = 0.040), high lactate levels (p = 0.020) on day 1 and high procalcitonin levels (p = 0.036) were found to have significant discrim- inating ability between survivors and non-survivors. Significantly shorter length of stay was observed amongst non-survivors (p = 0.002). Conclusions: In sepsis the JAAM DIC score identified most of the patients diagnosed by the overt ISTH criteria, but failed to discriminate between survivors and non-survivors amongst DIC patients. © 2011 Elsevier Ltd. All rights reserved. Introduction Disseminated intravascular coagulation (DIC) is a complication result- ing from various conditions including infection, trauma, and malignancy [1–3] that can lead to activation of coagulation pathways. DIC occurs in approximately 35% cases of sepsis [4,5]. In 2001 the scientific subcommit- tee of International Society of Thrombosis and Homeostasis (ISTH) de- fined DIC is an acquired syndrome characterized by intravascular activation of coagulation with loss of localization arising from different causes. It can originate from or cause damage to the micro-vasculature, which if sufficiently severe can produce organ dysfunction [6]. In sepsis this vicious cycle results from cross talk between the process of inflam- mation and coagulation [7]. Rangel-Frausto MS et al. in his prospective study of natural progression of systemic inflammatory response syn- drome (SIRS) demonstrated clinical hierarchical progression from SIRS to sepsis, severe sepsis, and septic shock along with a stepwise increase in DIC and organ dysfunction in critically ill patients [8]. Rapid diagnosis of DIC is highly desirable as initiation of early treat- ment [9] with interventions directed against coagulation and inflamma- tion associated with severe sepsis showed improved outcomes [5,9]. However, no single clinical or laboratory test has an adequate sensitivity and specificity to confirm or reject a diagnosis of DIC. Several biochem- ical markers of DIC like soluble fibrin levels, fibrin degraded products, D-Dimer and biphasic APTT waveform standalone have not found wide spread acceptability in clinical practice. Therefore, combinations of several readily available coagulation tests remain the cornerstone of diagnosis. Scoring systems to diagnose DIC were developed by Japanese Ministry of Health and Welfare (JMHW) in 1987 [10], ISTH in 2001 [6], and by Japanese Association for Acute Medicine (JAAM) in 2006 [11]. Some degree of arbitrariness in assigning power to individual parameters is an inherent property of various scoring systems. More- over a single gold standard diagnostic test is almost not possible as yet. Therefore, finding the very best scoring system is likely to remain a matter of further research and validation. Thrombosis Research 129 (2012) e119–e125 ⁎ Corresponding author. Tel.: + 91 522 2494548(Office); fax: +91 522 2668017. E-mail address: ratender@sgpgi.ac.in (R.K. Singh). 0049-3848/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.thromres.2011.11.017 Contents lists available at SciVerse ScienceDirect Thrombosis Research journal homepage: www.elsevier.com/locate/thromres