Diagnostic and prognostic value of Sepsis-Induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy

Sayyideh Forough Hosseini; Sahar Behnam-Roudsari; Ghazal Alavinia; Anahita Emami; Arash Toghyani; Sanaz Moradi; Mahtab Mojtahed Zadeh; Sana Mohseni; Mohammad Ali Shafiee

doi:10.4103/jrms.JRMS_1295_20

Diagnostic and prognostic value of Sepsis-Induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy

J Res Med Sci. 2021 Oct 18:26:102. doi: 10.4103/jrms.JRMS_1295_20. eCollection 2021.

Authors

Sayyideh Forough Hosseini¹, Sahar Behnam-Roudsari¹, Ghazal Alavinia¹, Anahita Emami¹, Arash Toghyani², Sanaz Moradi¹, Mahtab Mojtahed Zadeh¹, Sana Mohseni¹, Mohammad Ali Shafiee¹

Affiliations

¹ Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada.
² Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Background: The coronavirus disease 2019 (COVID-19) presents various phenotypes from asymptomatic involvement to death. Disseminated intravascular coagulopathy (DIC) is among the poor prognostic complications frequently observed in critical illness. To improve mortality, a timely diagnosis of DIC is essential. The International Society on Thrombosis and Hemostasis (ISTH) introduced a scoring system to detect overt DIC (score ≥5) and another category called sepsis-induced coagulopathy (SIC) to identify the initial stages of DIC (score ≥4). This study aimed to determine whether clinicians used these scoring systems while assessing COVID-19 patients and the role of relevant biomarkers in disease severity and outcome.

Materials and methods: An exhaustive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Cochrane, CINAHL, and PubMed until August 2020. Studies considering disease severity or outcome with at least two relevant biomarkers were included. For all studies, the definite, maximum, and minimum ISTH/SIC scores were calculated.

Results: A total of 37 papers and 12,463 cases were reviewed. Studies considering ISTH/SIC criteria to detect DIC suggested a higher rate of ISTH ≥5 and SIC ≥4 in severe cases and nonsurvivors compared with nonsevere cases and survivors. The calculated ISTH scores were dominantly higher in severe infections and nonsurvivors. Elevated D-dimer was the most consistent abnormality on admission.

Conclusion: Higher ISTH and SIC scores positively correlate with disease severity and death. In addition, more patients with severe disease and nonsurvivors met the ISTH and SIC scores for DIC. Given the high prevalence of coagulopathy in COVID-19 infection, dynamic monitoring of relevant biomarkers in the form of ISTH and SIC scoring systems is of great importance to timely detect DIC in suspicious patients.

Keywords: Coagulopathy; International Society on Thrombosis and Hemostasis; coronavirus disease 2019; disseminated intravascular coagulation; sepsis-induced coagulopathy score.

Publication types

Review