Diagnosis of Disseminated Intravascular Coagulation in the Context of Human Immunodeficiency Viral (HIV) Infections in a South African Tertiary Care Setting

E. Mayne¹, A. Mayne¹, S. Louw¹

¹Faculty of Health Sciences, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa

Abstract Number: PB0337

Meeting: ISTH 2021 Congress

Theme: Diagnostics and OMICs » Laboratory Diagnostics

Background: HIV infection is associated with an increased risk of abnormal thrombosis including microangiopathic thrombosis. Previously, HIV was not considered a direct cause of DIC but we have described it as a significant predisposing risk factor. A number of DIC scoring systems exist including the ISTH system which assigns points for prolongation of the prothrombin time (PT), presence of fibrin degradation products (D-dimers), reduced fibrinogen levels and thrombocytopaenia. Coagulation profiles may be deranged in HIV-infected patients in the absence of overt DIC. It becomes important, therefore, to describe the laboratory presentation in confirmed DIC in HIV-infected patients.

Aims: To evaluate the laboratory presentation of DIC in patients with and without HIV infection.

Methods: This study was approved by the human research ethics committee of the University of the Witwatersrand (M160389). ISTH DIC scores for all DIC screens between 2015 and 2016 were computed and patients with an ISTH score above 5 were included in the analysis. For the paired HIV-infected and HIV-uninfected patients, tests were recorded for the 4 parameters of the DIC score – PT, fibrinogen, D-dimers and platelets as well age. Since paired differences were normally distributed, a paired t-test for equality of means was performed with Stata^® -14.2. A p-value <0.05 was considered significant to reject equality of means.

Results: HIV-infected patients presented with DIC at a significantly younger age, significantly higher D-dimer levels, significantly prolonged PT values, lower fibrinogen levels, higher D-dimer levels and lower platelet counts than uninfected patients(Table 1). Clinically, the ISTH score was correspondingly higher in HIV-infected patients suggesting a more severe coagulopathy.

Parameter (units)	Age (years)		Prothrombin Time (PT) (seconds)		Fibrinogen (g/l)		D-dimer (mg/l)		Platelet (x10⁹/l)
HIV status	infected	uninfected	infected	uninfected	infected	uninfected	infected	uninfected	infected	uninfected
Mean	35.82	42.38	22.22	21.37	3.73	4.38	3.66	3.41	40.95	55.54
Variance	114.56	410.68	66.84	75.33	2.67	5.87	7.95	9.76	1136.16	3167.85
p-value	p<0.01		<0.01		<0.01		<0.01		<0.01

Comparison of the patient age and parameters of the ISTH DIC score between HIV infected and uninfected patients (n=112).

Conclusions: HIV-infected patients show activation of the coagulation system even in the absence of overt DIC and this derangement becomes pronounced when DIC develops. This should be considered when applying DIC scoring systems in the context of HIV infection.

To cite this abstract in AMA style:

Mayne E, Mayne A, Louw S. Diagnosis of Disseminated Intravascular Coagulation in the Context of Human Immunodeficiency Viral (HIV) Infections in a South African Tertiary Care Setting [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/diagnosis-of-disseminated-intravascular-coagulation-in-the-context-of-human-immunodeficiency-viral-hiv-infections-in-a-south-african-tertiary-care-setting/. Accessed September 24, 2021.

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