PB0633 - Scores in the real world: Evaluation of two disseminated intravascular coagulation (DIC) scores in three pediatric patients with decompensated End Stage Liver Disease (ESLD)

Background: The liver has an important role in hemostasis. ESLD is associated with significant changes in a patient’s coagulation profile and can be associated with both bleeding and clotting. DIC is a serious complication in critically ill pediatric patients. Different scores are avaiable to stablish DIC, but all of them include tests such as the prothrombin time (PT), activated partial thrombin time (aPTT), international normalized ratio (INR), fibrinogen, and platelet count, wich have significant limitations in ESLD patients.

Aims: Evaluation of the performance of ISTH overt DIC and JSTH's DIC (basic and infectious) scores in three paediatric patients with ESLD.

Methods: Patient1 (P1) is an 8-month-old girl with cholestatic cirrhotic liver disease who was admitted with febrile syndrome. Patient2 (P2) is a 3-year-old with liver cirrhosis secondary to biliary tract atresia (transplanted in 2023). Both patients developed SIC. P2 evolved favourably, P1 died 13 days after hospitalisation. Patient3 (P3) is an 18-year-old girl with cirrhosis due to autoimmune hepatitis admitted for decompensation. ISTH and JSTH scores for DIC were assessed in all three patients.

Results: See figures

Conclusion(s): Lack of cut-off points for DD, FDPs, platelets and PT limits their use. Treatment provided make the monitoring difficult implying a multidisciplinary approach with established algorithms for the stratification of the risk of developing DIC and the availability of early results. The JSTH score would serve as a starting point since it includes liver disease. In our report it´s clear that although 2 patients scored for both scores, one of them didn´t meet the clinical criteria, didn´t require therapeutic associated with coagulopathy, and nevertheless scored for DIC in both. The heterogeneity in values of the parameters involved reinforces the fact that a dedicated score is required. It is imperative to establish DIC scores for patients with ESLD and to validate them in pediatric patients with clinical trials.