Comparative Study of Different Diagnostic Criteria for Identifying Disseminated Intravascular Coagulation in Postpartum Hemorrhage
- VernacularTitle:不同诊断标准对严重产后出血人群弥散性血管内凝血诊断的比较研究
- Author:
Wenpeng YAO
1
;
Cheng LIU
;
Feng SUI
Author Information
1. 首都医科大学附属北京妇产医院/北京妇幼保健院:重症监护病房,北京 100006
- Publication Type:Journal Article
- Keywords:
Disseminated intravascular coagulation;
Obstetrics;
Diagnostic criteria
- From:
Journal of Practical Obstetrics and Gynecology
2025;41(7):591-597
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the diagnostic rates of disseminated intravascular coagulation(DIC)in ca-ses of postpartum hemorrhage,utilizing the obstetric standard of the Chinese DIC scoring system(CDSS)and the International Society on thrombosis and hemostasis(ISTH),and the differences in DIC diagnosis between the two diagnostic criteria.Methods:The cases with postpartum hemorrhage(blood loss＞1500 ml)from January 1,2016,to December 31,2020,in Beijing Obstetrics and Gynecology Hospital,Capital Medical University,were retro-spectively collected.Data included hemoglobin(Hb),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),international normalized ratio(INR),D-dimer(D-D),general patient information,transfusion records,comorbidities,and complications.Statistical analyses comprised comparative a-nalysis of coagulation profiles between diagnostic groups and ROC curve analysis to determine optimal diagnostic thresholds.Results:A total of 500 women with postpartum hemorrhage(blood loss＞1500 ml))were included in our study,88 cases(17.6％)met CDSS obstetric criteria for DIC,369 cases(73.8％)met ISTH,Poor diagnostic agreement,the Kappa value was 0.117.There were differences in blood loss volume,Hb,PLT,FIB,PT,APTT,prothrombin ratio(PTR),and D-D between the two diagnostic criteria for DIC(P＜0.01).FIB＜1.0g/L in 47 cases(9.4％),PT＜14 s in 368 cases(73.6％),D-D＜5mg/L in 93 cases(18.6％).Correlation analysis demonstrated CDSS scores showed correlation with PT(r=0.449)and PTR(r=0.441),ISTH scores with PT(r=0.574)and PTR(r=0.578).ROC analysis showed that when CDSS,ISTH and the two obstetric criteria were met,the area under the ROC curve(AUC)of PLT was 0.926,0.769 and 0.982,and FIB was 0.896,1.000 and 1.000,respective-ly.ROC analysis for CDSS criteria showed for FIB(cutoff 1.87g/L,sensitivity 85.4％,specificity 84.1％),that AUC values were 0.851 for PT(cutoff 14.05 s,sensitivity 73.9％,specificity 85.4％),for D-D(cutoff 24.03 mg/L,sensitiv-ity 77.3％,specificity 83.3％).Conclusions:The two DIC diagnostic scores differ in diagnosing DIC in patients with postpartum hemorrhage.PLT and FIB are more effective.The ISTH obstetrics standard,including only coagu-lation indices,can't distinguish DIC from dilution coagulation caused by postpartum hemorrhage.The scoring of FIB and PT according to the CDSS obstetric criteria may result in missed diagnoses,while the scoring of D-D may contribute to an increased false-positive rate.The scores for coagulation indices in obstetric DIC require further verification and adjustment.
