D-Dimer Efficacy Evaluated for Disseminated Intravascular Coagulation Diagnosis

Disseminated intravascular coagulation refers to an acquired syndrome characterized by procoagulant substances entering the general circulation and leading to a systemic thrombotic process, which may be derived from or causing microvascular system damage.

D-dimer (D-D) was shown to be an important indicator for the diagnosis of overt disseminated intravascular coagulation (DIC) and non-overt DIC; however, its diagnostic cutoff value in the clinic is not clearly defined. The initiation of treatment in nonovert DIC leads to better outcome than in DIC and therefore, early diagnosis of non-overt DIC is pivotal for DIC prevention and treatment.

Clinical scientists at the Nanjing Medical University (Suzhou, China) enrolled 40 male and 80 female cases in each group (DIC, non-overt DIC, and non-DIC control group). All 360 cases were collected in Suzhou Municipal Hospital. The DIC group included patients clearly diagnosed with DIC who had been hospitalized in the intensive care unit (ICU); the non-overt DIC group comprised patients who were diagnosed later as DIC; and the non-DIC control group included patients who were convalescing after surgery, had normal liver and kidney function.

D-D, fibrinogen degradation products (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fg), thrombin time (TT), antithrombin (AT), and blood platelet count (PLT) of 360 cases were used to assess the diagnostic efficacy of Innovance D-Dimer reagent (Siemens Healthcare Diagnostics, Erlangen, Germany) for the diagnosis of DIC and non-overt DIC, compared to, or combined with, other DIC coagulation indicators. D-D was quantitatively analyzed using a Sysmex CA1500 automatic coagulation analyzer (Sysmex Corporation; Kobe, Japan) with an immunoturbidimetric method.

The investigators found that when D-D was greater than 3.0 μg/mL was used as the cutoff, the sum of diagnostic sensitivity and specificity reached maximum values for DIC and non-overt DIC, whereas the sum of misdiagnoses and missed diagnosis rate was minimal. Excluding D-D, AT, or Fg, but not TT, from the test combination reduced the diagnostic sensitivity of DIC or non-overt DIC by various degrees. Combining two factors, D-D of greater than 3.0 μg/mL and FDP of greater than 10 mg/L, increased the sensitivity and specificity for the diagnosis of DIC and non-overt DIC.

The authors concluded that monitoring D-D and FDP levels is useful for early intervention and improving microcirculation disturbance caused by disease. They propose that a cutoff value of D-D of greater than 3.0 μg/mL would be suitable for the InnovanceR D-D reagent in the laboratory; D-D in combination with FDP is meaningful for primary screening of non-overt DIC. The study was published on February 2, 2016, in the International Journal of Laboratory Hematology.

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Nanjing Medical University 
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