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

doi:10.3969/j.issn.1006-5725.2024.02.021

Abstract

Abstract:

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

CLC Number:

Fangmin GENG,Yuandan HE,Wenjuan LI,Qianqian LIU,Hongwei ZHANG,Zhangping LU,Lianhua WEI. Values of different DIC scoring systems in early diagnosis and prognosis prediction of coagulation dysfunction in sepsis patients[J]. The Journal of Practical Medicine, 2024, 40(2): 248-252.

Figures/Tables 7

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References 21

1	MICHELA G， HANNE EHELINDER B， DARIO B， et al. Coagulopathy and sepsis： Pathophysiology， clinical manifestations and treatment［J］. Blood Rev，2021，50：100864. doi:10.1016/j.blre.2021.100864 doi: 10.1016/j.blre.2021.100864
2	EVANS L， RHODES A， ALHAZZANI W， et al. Surviving Sepsis Campaign： International Guidelines for Management of Sepsis and Septic Shock 2021［J］.Intenstive Care Med，2021，47（11）：1181-1247.
3	RUDD K， JOHNSON S， AGESA K， et al. Global， regional， and national sepsis incidence and mortality， 1990-2017： analysis for the Global Burden of Disease Study［J］. Lancet，2020，395（10219）：200-211. doi:10.1016/s0140-6736(19)32989-7 doi: 10.1016/s0140-6736(19)32989-7
4	张杰，李小悦，黄家华，等. 脓毒症相关肝损伤与肠-肝轴研究进展［J］.实用医学杂志，2022，38（7）：795-798. doi:10.3969/j.issn.1006-5725.2022.07.004 doi: 10.3969/j.issn.1006-5725.2022.07.004
5	LEVIL M， TENC H. Disseminated intravascular coagulation ［J］.N Engl J Med，1999，341：586-592. doi:10.1056/nejm199908193410807 doi: 10.1056/nejm199908193410807
6	RHODES A， EVANS L， ALHAZZANI W， et al. Surviving sepsis campaign： international guidelines for management of sepsis and septic shock： 2016［J］. Crit Care Med， 2017， 45（3）： 486-552.
7	CHURPEK M， SNYDER A， HAN X， et al. Quick sepsis-related organ failure assessment， systemic inflammatory response syndrome， and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit［J］. Am J Respir Crit Care Med， 2017， 195（7）： 906-911. doi:10.1164/rccm.201604-0854oc doi: 10.1164/rccm.201604-0854oc
8	TACKE F， RDERBURG C， BENZ F， et al. Levels of circulating miR-133a are elevated in sepsis and predict mortality in critically ill patients ［J］. Crit Care Med， 2014， 42（5）： 1096-1104. doi:10.1097/ccm.0000000000000131 doi: 10.1097/ccm.0000000000000131
9	SAMANTHA E， HOFFMAN B， BLAKE M， et al. Spinal Level and Cord Involvement Predict Sepsis Following Vertebral Fracture Repair for Traumatic Spinal Injury［J］. Neurosurg Spine，2022，4： 1-7.
10	YAMAKAWA K， YOSHIMURA J， ITO T， et al. External Validation of the two newly proposed criteriafor assessing coagulopathy in sepsis［J］. Thromb Haemost， 2019，119（2）：203-212. doi:10.1055/s-0038-1676610 doi: 10.1055/s-0038-1676610
11	TOSHIAKI I， JERROL D， LEVY. Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation［J］ .Anesthesiology，2020，132（5）：1238-1245. doi:10.1097/aln.0000000000003122 doi: 10.1097/aln.0000000000003122
12	YUTAKA U， KAZUMA Y， TAKEYUKI K， et al Design and Evaluation of New Unified Criteria for Disseminated Intravascular Coagulation Based on the Japanese Association for Acute Medicine Criteria［J］. Clin Appl Thromb Hemost， 2016，22（2）：153-160. doi:10.1177/1076029615591169 doi: 10.1177/1076029615591169
13	JULIE BROGAARD L， MATHIES APPEL A， ASGER G， et al Disseminated intravascular coagulation diagnosis ： Positive predictive value of the ISTH score in a Danish population ［J］. Res Pract Thromb Haemost， 2021，5（8）：e12636. doi:10.1002/rth2.12636 doi: 10.1002/rth2.12636
14	SINGER M， DEUTSCHMAN C， SEYMOUR C，et al. The Third International Consensus Definitions for Sepsis and Septic Shock （Sepsis-3）［J］. JAMA， 2016，315（8）： 801–810.
15	PRIYA P， AMANDA W， MATTHEW R， et al. Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation［J］.Clin Appl Thromb Hemost， 2019， 25： 1-6. doi:10.1177/1076029619843338 doi: 10.1177/1076029619843338
16	宋立成，韩志海. 脓毒症相关凝血功能障碍机制及治疗的研究进展［J］. 中华危重症医学杂志（电子版）， 2017， 10（2）：125-129.
17	TOSHIAKI I， MAKOTO ARAKOTO A， JERROLD H.Sepsis-inducedcoagulopathy and Japanese association for acute medicineDic in coagulopathic patients with decreased antithrombinand treated by antithrombin［J］. Clin Appl Thromb Hemost， 2018， 24（7）：1020-1026. doi:10.1177/1076029618770273 doi: 10.1177/1076029618770273
18	THROMBUS AND HEMOSTASIS GROUP. Chinese Society of Hematology， Chinese Medical Association.Chinese expert Consensus on diagnosis of disseminated intravascular coagulation （2017 edition）［J］. Chin J Hematol， 2017，38 （5）： 361-363 .
19	WANG B， ZHANG B， SHEN Y， et al. Validation of two revised，simplified criteria for assessing sepsis-associated disseminated intravascular coagulation in ICU patients with sepsis-3： a retrospective study［J］. Lab Med， 2023，54（3）：291-298. doi:10.1093/labmed/lmac112 doi: 10.1093/labmed/lmac112
20	UMEMURA Y， YAMAKAWA K. Optimal patient selection for anticoagulant therapy in sepsis： an evidence-based proposal from Japan［J］. Thromb Haemost， 2018，16（3）：462-464. doi:10.1111/jth.13946 doi: 10.1111/jth.13946
21	CHIE T， TAKASHI T， SAORI， et al. Validation of sepsis-induced coagulopathy score in critically ill patients with septic shock： post hoc analysis of a nationwide multicenter observational study in Japan［J］. Internat J Hematol，2021，114：164-171. doi:10.1007/s12185-021-03152-4 doi: 10.1007/s12185-021-03152-4

项目	分数	ISTH	非显性ISTH	JAAM	JMHW	CDSS
血小板（10⁹/L）	0	> 100	> 100	≥ 120	> 120	≥ 100
	1	≤ 100	≤ 100	≥ 80，< 120	≥ 80，< 120	≥ 80，< 100
	2	< 50	< 50		> 50，≤ 80	< 80
	3			< 80	≤ 50
PT（s）	0	< 3	< 3	< 1.2（PT ratio）	< 1.25（PT ratio）
	1	≥ 3，< 6	≥ 3，< 6	≥ 1.2	≥ 1.25，< 1.67
	2	≥ 6	≥ 6		≥ 1.67
纤维蛋白相关标记物（mg/L）	0	DDI < 0.4	DDI < 0.4	FDP < 10	FDP < 10	DDI < 5
	1			10 ≤ FDP < 25	10 ≤ FDP < 20
	2	0.4 ≤ DDI < 4.0	0.4 ≤ DDI < 4.0		20 ≤ FDP < 40	5 ≤ DDI < 9
	3	DDI ≥ 4.0	DDI ≥ 4.0	≥ 25	> 40	DDI ≥ 9
纤维蛋白原（g/L）	0	> 1.0		> 3.5	> 1.5	≥ 1.0
	1	≤ 1.0		≤ 3.5	1.0 < and ≤ 1.5	< 1.0
	2				≤ 1.0
SIRS 评分	0-2			0
	≥3			1
有导致DIC的基础疾病	1
有导致DIC的基础疾病	2				1	2
出血	1				1	1
循环衰竭	1					1
器官衰竭	1				1	1
DIC评分		DIC ≥ 5	DIC ≥ 4	DIC ≥ 5	DIC ≥ 7	DIC ≥ 7

观察指标	脓毒症组	脓毒症休克组	H/χ²值	P值
性别［例（%）］			0.903	0.342
男	34（59.65）	10（47.6）
女	23（40.35）	11（52.4）
年龄［M（P₂₅，P₇₅），岁］	60（52，74）	59（46，65）	2.142	0.032
住院时间	10（6，17）	10（5，16）	0.34	0.973
出院转归［例（%）］			6.334	0.012
治愈与好转	48（84.2%）	12（57.1%）
死亡与未愈	9（15.8%）	9（42.9%）

项目	DIC	NON-DIC	H值
JMHW	5（6.4）	73（93.6）	4.158
CDSS	7（9.0）	71（91.0）	4.866
ISTH	10（12.8）	68（87.2）	5.483
非显性 ISTH	23（29.5）	55（70.5）	3.197
JAAM	27（35.9）	51（64.1）	7.477

评分系统	分组	DIC	非DIC	χ²值	P值
ISTH				0.997	0.318
	脓毒症	6（10.5）	51（89.5）
	脓毒症休克	4（19.1）	17（80.9）
非显性STH				7.244	0.007
	脓毒症	12（21.0）	45（79.0）
	脓毒症休克	11（52.4）	10（47.6）
CDSS				0.11	0.918
	脓毒症	5（8.8）	52（91.2）
	脓毒症休克	2（9.5）	19（91.5）
JAAM				6.443	0.011
	脓毒症	15（26.3）	42（73.3）
	脓毒症休克	12（57.1）	9（42.9）
JWHM				0.464	0.496
	脓毒症	3（5.3）	54（94.7）
	脓毒症休克	2（9.5）	19（91.5）

评分系统	好转与治愈	未愈与死亡	χ²值	P值
JAAM			10.621	0.001
DIC	15（55.6）	12（44.4）
非DIC	45（88.2）	6（11.8）
JMHW			6.652	0.01
DIC	1（20）	4（80）
非DIC	59（80.8）	14（19.2）
CDSS			7.357	0.007
DIC	2（28.6）	5（71.4）
非DIC	58（81.7）	13（18.1）
ISTH			5.229	0.022
DIC	5（45.5）	6（54.5）
非DIC	55（82.1）	12（17.9）
非显性ISTH			8.382	0.004
DIC	13（56.5）	10（43.4）
非DIC	47（85.4）	8（14.5）

Values of different DIC scoring systems in early diagnosis and prognosis prediction of coagulation dysfunction in sepsis patients

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项目	面积	P值	95%CI	Cutoff值	敏感性	特异性
CDSS	0.675	0.018	0.534 ~ 0.816	0.346	0.714	0.947
JMHW	0.637	0.064	0.485 ~ 0.790	0.361	0.714	0.982
JAAM	0.614	0.126	0.465 ~ 0.762	0.313	0.762	0.964
非显性ISTH	0.686	0.012	0.550 ~ 0.821	0.313	0.762	0.895
ISTH	0.686	0.012	0.550 ~ 0.821	0.313	0.762	0.895

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