Potential utility of the new ISTH overt disseminated intravascular coagulation scoring system for mortality risk assessment of patients with sepsis, hematopoietic neoplasms, and solid cancers: a nation-wide database study in Japan.

BACKGROUND

Disseminated intravascular coagulation (DIC) is characterized by systemic activation of coagulation pathways within the microvasculature, ultimately resulting in multiorgan dysfunction. The International Society on Thrombosis and Haemostasis (ISTH) subcommittee has recently introduced the 2025 overt DIC scoring system for clinical diagnosis.

OBJECTIVES

This study aimed to evaluate the clinical relevance of the 2025 ISTH overt DIC scoring system and its proposed cutoff values for the mortality risk assessment in patients with diverse underlying diseases.

METHODS

Patient data were extracted from the Japan Medical Data Center database, focusing on individuals diagnosed with sepsis, hematopoietic neoplasms, or solid cancers. Patients were included only if baseline levels of fibrinogen, platelets, prothrombin time (PT), and fibrin-related markers were available on the day of admission. Restricted cubic spline models were applied to evaluate nonlinear associations between coagulation parameters and in-hospital death.

RESULTS

Data from 8181 patients with sepsis, 7548 patients with hematopoietic neoplasms, and 11 614 with solid cancers revealed a marked increase in mortality associated with fibrinogen < 2 g/L, platelets < 100 × 109/L, PT >14 seconds, and D-dimer > 3 mg/L. Among these, PT prolongation and elevated D-dimer demonstrated the strongest associations with mortality. Across all 3 disease groups, in-hospital mortality showed a consistent positive correlation with the ISTH DIC sum score.

CONCLUSION

These findings support the prognostic utility of the 2025 ISTH overt DIC scoring system and its proposed cutoff values in evaluating mortality risk among patients with sepsis, hematopoietic malignancies, and solid cancers.