International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation ≥6: a new predictor of hemorrhagic early death in acute promyelocytic leukemia

• Published in: Medical oncology (Northwood, London, England) Vol. 30; no. 1; p. 478
• Main Authors: Mitrovic, Mirjana, Suvajdzic, Nada, Bogdanovic, Andrija, Kurtovic, Nada Kraguljac, Sretenovic, Aleksandra, Elezovic, Ivo, Tomin, Dragica
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.03.2013; Springer Nature B.V
• Subjects: Adult; Aged; Blood Coagulation Tests; Disseminated Intravascular Coagulation - diagnosis; Disseminated Intravascular Coagulation - etiology; Disseminated Intravascular Coagulation - mortality; Female; Hematology; Humans; Internal Medicine; Leukemia; Leukemia, Promyelocytic, Acute - complications; Leukemia, Promyelocytic, Acute - mortality; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Paper; Pathology; Young Adult; ISTH DIC score; Acute promyelocytic leukemia; Hemorrhagic early death; ATRA
• ISSN: 1357-0560; 1559-131X; 1559-131X
• DOI: 10.1007/s12032-013-0478-y

High-hemorrhagic early death (ED) rate is a major impediment in the managing of acute promyelocytic leukemia (APL). In our group of 56 newly diagnosed APL patients, ED occurred in 12 subjects, due to endocranial bleeding (8/12), differentiation syndrome (2/12), or infection (2/12). Predictors of hemorrhagic ED were as follows: white blood cells count ≥20 × 10 9 /L ( P  =  0.002337 ), Eastern cooperative oncology group performance status ≥3 ( P  =  0.00173 ), fibrinogen level <2 g/L ( P  =  0.004907 ), prothrombin time <50% ( P  =  0.0124 ), and International Society of Thrombosis and Hemostasis Scoring System for disseminated intravascular coagulation (ISTH DIC score) ≥6 ( P  =  0.00741 ). Multivariate analysis indicated ISTH DIC score ≥6 to be the most significant predictor for hemorrhagic ED ( P  =  0.008 ). The main finding of this study is that simple coagulation-related tests, performed on hospital admission and combined in the ISTH DIC score, might help to identify patients at high risk for fatal bleeding needing more aggressive supportive measures.