PB0833 - Potential utility of the ISTH overt DIC scoring system for the risk assessment of patients with sepsis: a population-based cohort study in Japan

Background: Sepsis is a leading cause of death among critically ill patients in the intensive care units. Disseminated intravascular coagulation (DIC) occurs in 25–50% of patients with sepsis, and is associated with poor outcomes. For clinical diagnosis of overt DIC, the ISTH subcommittee on DIC proposed a scoring system based on coagulation test values, including fibrinogen levels, platelet counts, prothrombin time (PT), and fibrin degradation product (FDP) levels. Several studies have shown the potential utility of this scoring system so far, however, further validation with larger cohorts is required.

Aims: The aim of this study was to evaluate the relevance of the ISTH overt DIC scoring system and its cutoff values for the risk assessment of patients with sepsis.

Methods: From the database provided by JMDC Inc., we extracted the fully anonymized data of patients with sepsis, defines as those with infectious diseases and organ failure. Among 66,536 patients with sepsis hospitalized between April 2014 and April 2024, 8,181 patients were selected based on the availability of data of fibrinogen, platelets, PT, and FDP levels at the first day of admission. The association between the coagulation test values and in-hospital mortality was analyzed in these 8,181 patients.

Results: The mortality increased sharply at a fibrinogen level of < 2 g/L, a platelet level of < 100 ×10^9/L, a PT ratio of > 1.2, and an FDP level of > 5 mg/L. Then, the mortality hit its peak at a PT ratio of 1.8 and an FDP level of 35 mg/L. The mortality correlated well with the ISTH DIC sum score.

Conclusion(s): These findings demonstrate relevance of the ISTH overt DIC scoring system and its cutoff values in terms of risk assessment of patients with sepsis.