Next Article in Journal
Eosinophilic Liver Abscess Mimicking Intrahepatic Cholangiocarcinoma on 18F-FDG PET-CT: A Case Report
Next Article in Special Issue
Time-Dependent Prognostic Value of the mEASIX Score in Patients with Myelodysplastic Syndromes
Previous Article in Journal
When the All-Purpose Tool Fails: Manufacturer-Specific Time Dependency of Magnet Mode in Cardiac Implantable Electronic Devices
Previous Article in Special Issue
The Diagnostic Performance of the Cellavision DC-1 Digital Morphology Analyser on Leukaemia Samples
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Diagnostics
Volume 15
Issue 23
10.3390/diagnostics15233053
diagnostics-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Predicting Bleeding in AML-Associated DIC: Limitations of the ISTH Score and a Modified Approach

by
Bedrettin Orhan
1,*,
Fahir Özkalemkaş
1,
Tuba Bayır
2,
Cumali Yalçın
1,
Büşra Güner
3,
Ezel Elgün
1,
Esra Gülderen
3,
Ayşe Bulur
3,
Tuba Ersal
1,
Fazıl Çağrı Hunutlu
1,
Tuba Güllü Koca
1,
Sinem Çubukçu
1,
Şeyma Yavuz
1 and
Vildan Özkocaman
1
1
Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey
2
Department of Biometrics, Faculty of Veterinary Medicine, Fırat University, Elazig 23119, Turkey
3
Department of General Internal Medicine, Faculty of Medicine, Bursa Uludag University, Bursa 16059, Turkey
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(23), 3053; https://doi.org/10.3390/diagnostics15233053
Submission received: 12 October 2025 / Revised: 25 November 2025 / Accepted: 28 November 2025 / Published: 29 November 2025
(This article belongs to the Special Issue Diagnosis and Prognosis of Hematological Disease)
Browse Figures
Versions Notes

Abstract

Background and Objectives: Bleeding is a major cause of mortality in cases of acute myeloid leukemia (AML)-associated disseminated intravascular coagulation (DIC). The predictive power of the standard International Society on Thrombosis and Hemostasis (ISTH) score for bleeding in patients diagnosed with AML is limited. This study aimed to evaluate the performance of the standard ISTH score and modified versions in predicting bleeding among acute promyelocytic leukemia (APL, M3) and non-APL AML subgroups. Methods: This single-center, retrospective study included 190 AML patients (61 APL, 129 non-APL). The predictive power of the original ISTH score and eight different modified scores—incorporating parameters such as lactate dehydrogenase (LDH) and genetic positivity—for DIC-related bleeding was assessed using receiver operating characteristic (ROC) analysis. Results: In the APL group, the original ISTH score was statistically significant in predicting DIC-related bleeding (AUC = 0.727), but the modifications did not improve performance. In the non-APL AML group, the original score did not predict bleeding (AUC = 0.632, p = 0.079). However, a modified ISTH score excluding D-dimer and including LDH (≥800 mg/dL) and genetic positivity significantly improved prediction (AUC = 0.710, p = 0.005). This modification increased specificity from 48.2% to 60.7% and sensitivity from 76.5% to 82.4%. Conclusions: A subtype-specific approach is required to predict bleeding risk in AML-associated DIC. Modified ISTH scores remain suboptimal for APL; however, a modified score incorporating LDH and genetic status represents a promising tool to identify non-APL AML patients at risk of bleeding and warrants prospective validation.
Keywords: acute myeloid leukemia; bleeding; disseminated intravascular coagulation; genetics acute myeloid leukemia; bleeding; disseminated intravascular coagulation; genetics

Share and Cite

MDPI and ACS Style

Orhan, B.; Özkalemkaş, F.; Bayır, T.; Yalçın, C.; Güner, B.; Elgün, E.; Gülderen, E.; Bulur, A.; Ersal, T.; Hunutlu, F.Ç.; et al. Predicting Bleeding in AML-Associated DIC: Limitations of the ISTH Score and a Modified Approach. Diagnostics 2025, 15, 3053. https://doi.org/10.3390/diagnostics15233053

AMA Style

Orhan B, Özkalemkaş F, Bayır T, Yalçın C, Güner B, Elgün E, Gülderen E, Bulur A, Ersal T, Hunutlu FÇ, et al. Predicting Bleeding in AML-Associated DIC: Limitations of the ISTH Score and a Modified Approach. Diagnostics. 2025; 15(23):3053. https://doi.org/10.3390/diagnostics15233053

Chicago/Turabian Style

Orhan, Bedrettin, Fahir Özkalemkaş, Tuba Bayır, Cumali Yalçın, Büşra Güner, Ezel Elgün, Esra Gülderen, Ayşe Bulur, Tuba Ersal, Fazıl Çağrı Hunutlu, and et al. 2025. "Predicting Bleeding in AML-Associated DIC: Limitations of the ISTH Score and a Modified Approach" Diagnostics 15, no. 23: 3053. https://doi.org/10.3390/diagnostics15233053

APA Style

Orhan, B., Özkalemkaş, F., Bayır, T., Yalçın, C., Güner, B., Elgün, E., Gülderen, E., Bulur, A., Ersal, T., Hunutlu, F. Ç., Koca, T. G., Çubukçu, S., Yavuz, Ş., & Özkocaman, V. (2025). Predicting Bleeding in AML-Associated DIC: Limitations of the ISTH Score and a Modified Approach. Diagnostics, 15(23), 3053. https://doi.org/10.3390/diagnostics15233053

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop