收稿日期: 2023-08-21
网络出版日期: 2024-03-06
基金资助
国家自然科学基金资助项目(81960385);甘肃省人民医院院内科研基金项目(16GSSY2-6);兰州市中医药管理局科研项目(GZK-2012-17)
Values of different DIC scoring systems in early diagnosis and prognosis prediction of coagulation dysfunction in sepsis patients
Received date: 2023-08-21
Online published: 2024-03-06
目的 基于脓毒症患者评价5种DIC评分系统，探讨不同DIC评分系统在诊断脓毒症患者中DIC发生和预后的价值，比较不同的DIC评分系统对脓毒症并发DIC的适用性。 方法 回顾性分析2019年12月1日至2021年12月31日于甘肃省人民医院住院部收治的脓毒症患者24ｈ内的实验室指标和临床资料。分别使用5种DIC评分系统进行评分，比较5种DIC评分系统在不同严重程度的脓毒症患者中诊断率及出院转归的差异；绘制5种DIC评分系统的ROC曲线，评估各个评分系统在诊断脓毒症患者中DIC的准确性。 结果 脓毒症的病死率随着脓毒症严重程度加重逐渐升高（P < 0.05）；5种评分系统DIC与非DIC的出院转归比较，差异均有统计学意义（P < 0.05）；JAAM诊断的病例中包含了JMHW、CDSS和部分ISTH，非显性ISTH诊断的病例中包含了ISTH；ISTH、JAAM、JMHW、CDSS、非显性ISTH 5种评分系统诊断DIC病例中，未愈与死亡分别是非DIC病例的3.0、3.8、4.2、3.9、3.0倍。 结论 JAAM评分系统对于成人脓毒症患者的诊断率和敏感性较高；CDSS和JMHW评分系统对脓毒症患者预后判断的准确性较好。
耿方敏 , 贺元旦 , 李文娟 , 刘茜茜 , 张红微 , 陆章平 , 魏莲花 . 不同DIC评分系统对脓毒症患者凝血功能障碍早期诊断和预后预测的价值[J]. 实用医学杂志, 2024 , 40(2) : 248 -252 . DOI: 10.3969/j.issn.1006-5725.2024.02.021
Objective To evaluate five types of DIC scoring systems based on sepsis patients， to explore the values of different DIC scoring systems in the occurrence and prognosis of DIC in sepsis patients， and to compare the applicability of different DIC scoring systems for sepsis complicated with DIC. Methods Laboratory indexes and clinical data from sepsis patients who had been hospitalized in Gansu Provincial People's Hospital from December 1， 2019 to December 31， 2021 were retrospectively analyzed within 24 hours. Five types of DIC scoring systems were used to score， and the difference of diagnostic rate and discharge outcome in sepsis patients with different severity was compared. The ROC curves of five DIC scoring systems were established to evaluate the accuracy of DIC in sepsis patients. Results The fatality rate of sepsis increased with the severity of sepsis （P < 0.05）. There were statistically significant differences in discharge outcomes between DIC and non-DIC in the five scoring systems （P < 0.05）. JMHW， CDSS and part of ISTH were detected in JAAM cases， while ISTH was detected in non-dominant ISTH cases. ISTH， JAAM， JMHW， CDSS， and non-dominant ISTH5 scoring systems were used to diagnose DIC， and absence of full health restoration and death were 3.0， 3.8， 4.2， 3.9， and 3.0 times higher than non-DIC cases， respectively. Conclusion JAAM scoring system has higher diagnostic rate and sensitivity for adult sepsis. CDSS and JMHW scoring systems are more accurate in predicting the prognosis of sepsis patients.
Key words： sepsis; DIC; scoring systems; diagnostic efficacy
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