An application of medical decision making to DIC diagnosis in trauma patients. Selection of new molecular markers and determining their optimal cut-off points.:Selection of New Molecular Markers and Determining their Optimal Cut-Off Points
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For the appropriate use of new molecular markers and determination of their optimal cut-off points in the diagonsis of disseminated intravascular coagulation (DIC) in trauma patients, we examined coagulation and fibrinolysis by measuring fibrinopeptide A (FPA), fibrinopeptide Bβ15-42 (FPBβ15-4215-42), α2 plasmin inhibitor-plasmin-complex (PAC), and cross-linked fibrin degradation product (D-dimer), on admission to an emergency room then 3 and 6 days later, in 64 adult trauma patients. We used the 1988 revised Japanese DIC diagnostic criteria (requiring score of 7 points or more) as a gold standard for DIC diagnosis. Receiver operating characteristic (ROC) curve analysis was used to evaluate these four molecular markers. The area under the ROC curves and the standard error of each molecular marker were compared, then the Z-statistic for differences in ROC area was calculated. Finally, we determined the optimal cut-off points of the molecular markers at the DIC scores of 5 and 6 using the ROC curves. The results suggest that measuring FPA, FPBβ15-42, and D-dirner could be useful in the diagnosis of DIC in trauma patients.The optimal cut-off points at the DIC scores of 5 and 6 for these molecular markers were FPA (30, 10ng/ml), FPBβ15-42 (40, 20ng/ml), and D-dimer (4, 000, 2, 000ng/ml). In conclusion, we propose new diagnostic criteria for DIC in trauma by application of the 1988 Japanese DIC diagnostic criteria, i.e., if the score is 7 or more, then diagnosis of DIC is established, but if the score is 6 (indicating DIC is probable) or 5 (indicating it is possible), then a diagnosis of DIC can be made if the following conditions are met: a) FPA>10ng/ml or FPB β15-42>20ng/ml or D-dimer>2, 000ng/ml, and b) FPA>30ng/ml and FPBβ15-42>40ng/ml and D-dimer>4, 000ng/ml.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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