A Study of the Prognostic Value of Smartphone Application on Disseminated Intravascular Coagulation (DIC) Score in Prediction of 28-day Mortality
ISTH Academy. Thamgrang T. Jul 9, 2019; 264587; PB1397 Topic: Disseminated Intravascular Coagulation
Dr. Tanapun Thamgrang
Dr. Tanapun Thamgrang
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A Study of the Prognostic Value of Smartphone Application on Disseminated Intravascular Coagulation (DIC) Score in Prediction of 28-day Mortality

T. Thamgrang, C. Sirisuksakun, K. Prayongratana
Phramongkutklao Hospital, Department of Medicine, Bangkok, Thailand

Main Topic: Hemophilia and Bleeding (including Transfusion)
Category: Disseminated Intravascular Coagulation

Background: The International Society of Thrombosis and Haemostasis DIC scoring system was developed to guide in diagnosis of DIC. However, the use of this scoring system in clinical practice has been limited as clinicians prefer to diagnose this syndrome by their experience. DIC score smartphone application was developed to diagnose DIC easily and accurately.
Aims: To demonstrate the prognostic values of DIC score by using DIC score smartphone application as a predicting tool of 28-day mortality in terms of sensitivity, specificity and accuracy.
Methods: The prospective observational cohort was conducted. DIC score was calculated for each patient who was complicated with clinical suspicious of DIC. The sensitivity, specificity, accuracy and correlation of poorer outcomes of 28-day mortality were evaluated.
Results: 150 inpatients complicated with clinical suspicious of DIC were enrolled. The most common etiology of DIC was infection/sepsis (79.3%). The 28-day mortality rate was 33.3%. The sensitivity, specificity and accuracy in prediction of 28-day mortality by using DIC score smartphone application were 62.0%, 72.0% and 68.7%, respectively. Among the parameters in the application, only prothrombin time (23.5 and 15.5 sec; p < 0.001) and fibrinogen level (289.5 and 383.5 mg/dL; p = 0.0047) were significantly different between non-survivors and survivors, respectively. Patients with a higher DIC score documented by the application were also associated with a higher mortality rate particularly patient with a score higher than 4. (Figure 1) Additionally, survival analyses of patients were performed which showed that patients with overt-DIC group had a statistically significant lower rate of survival at 28 days when compared to that of non-overt DIC group; 55.88% and 73.53%; p-value = 0.002. (Figure 2)
Conclusions: DIC score smartphone application can be used as a clinical tool to predict 28-day mortality. Patients with higher DIC scores, prolonged prothrombin time and lower fibrinogen level were associated with poorer survival outcome.

[Figure 1. Relationship between DIC score and 28-day mortality]

[Figure 2. Kaplan-Meier analysis of survival in patients with overt DIC and non-overt DIC]

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