Predictability of disseminated intravascular coagulation based on the decrease rate of platelets

Purpose

To investigate whether the decrease rate of platelets is useful for early diagnosis of disseminated intravascular coagulation (DIC).

Subjects and methods

A retrospective clinical study was performed in 454 consecutive patients who were admitted to our intensive critical care unit between 1 June and 1 October 2003. The patients whose platelet count decreased to be less than 10 × 10⁴/μl during the course of a disease were regarded to be in a state of pre-DIC, and the relation between the subsequent decrease rate of platelets (ΔPLT) and the occurrence of DIC was investigated. ΔPLT was obtained as follows: (platelet count when platelets started to decrease - minimum platelet count subsequently observed / the number of days required to observe the minimum platelet count after platelets started to decrease).

Result

The platelet count decreased to be less than 10 × 10⁴/μl in 41 out of 454 patients during their hospital stay. Among these 41 patients, 28 (70%) developed DIC. There was no significant difference in age, sex, APACHE II score, SOFA score, or frequency of systemic inflammatory response syndrome between DIC and non-DIC patients. When the platelet count, the International Normalised Ratio, the fibrinogen level, the fibrin/fibrinogen degradation product (FDP) value, and the most abnormal white blood cell count in non-DIC patients were compared with those observed at the time of DIC onset in DIC patients, only the FDP value was significantly higher in DIC patients (non-DIC:DIC, 8.49 ± 3.40 μg/ml:59.6 ± 86.2 μg/ml; P < 0.05). ΔPLT was significantly higher in DIC patients (6.55 ± 8.41/μl/day) than in non-DIC patients ([2.24 ± 1.87] × 10⁴/μl/day).

Conclusion

The patients who had less than 10 × 10⁴/μl platelets and whose platelets decreased by 6.55 × 10⁴/μl/day on average had a strong possibility to develop DIC.