D-二聚体、乳酸联合可溶性血小板内皮黏附分子-1对脓毒症相关弥散性血管内凝血患者预后不良的预测研究

doi:10.3969/j.issn.1006-5725.2023.18.016

Abstract

Abstract:

Objective To investigate the predictive value of D?dimer （D?D）， lactic acid， and soluble platelet endothelial adhesion molecule?1 （sPECAM?1） in patients with sepsis?associated disseminated intravascular coagulation （DIC）. Methods According to the prognosis of patients at 28 days， 300 patients with sepsis?related DIC in the ICU of the Affiliated Hospital of Xuzhou Medical University were gathered and split into death and survival groups. The two groups' general statistics， APACHEⅡ score， serum D?D， lactate， and sPECAM?1 levels were compared. The operating characteristic curve （ROC） was used to evaluate the predictive value of serum D?D， lactate， and sPECAM?1 on the poor prognosis of patients with sepsis?related DIC. Results The 28?day mortality rate of patients with sepsis?related DIC was 22%， and the death group had higher APACHEⅡ scores， serum D?D， lactate， and sPECAM?1 levels than the survival group （P < 0.05）. Multivariate logistic regression results showed that serum D?D， lactic acid and sPECAM?1 were risk factors for 28?day death in patients with sepsis?related DIC.The AUC of serum D?D， lactic acid， and sPECAM?1 was 0.863 （95%CI： 0.768 ~ 0.958）， 0.831 （95%CI： 0.734 ~ 0.928）， 0.774 （95%CI： 0.653 ~ 0.896）， respectively. The AUC of the combination of serum D?D， lactic acid and sPECAM?1 was 0.965 （95%CI： 0.928 ~ 1.000）， with the sensitivity 0.864 and the specificity 0.974， each of which were greater than the individual predictions. Conclusion In patients with sepsis?related DIC， higher serum D?D， lactate， and sPECAM?1 levels were highly correlated with 28?day death.In patients with sepsis?related DIC， higher serum D?D， lactate， and sPECAM?1 levels were highly correlated with 28?day death. The combination of serum D?D， lactate， and sPECAM?1 levels provided a high predictive value for the prognosis of sepsis?related DIC and might be employed in therapeutic treatment.

Key words: sepsis, disseminated intravascular coagulation, D?dimer, lactic acid, soluble platelet endothelial adhesion molecule?1

CLC Number:

R631+.4

Ziwen WANG,Wenjing ZHAO,Yali. CHAO. D⁃dimer and lactic acid combined with sPECAM⁃1 in the prediction of poor prognosis in patients with sepsis⁃related disseminated intravascular coagulation[J]. The Journal of Practical Medicine, 2023, 39(18): 2379-2383.

Figures/Tables 4

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References 21

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变量名	存活组（n = 234）	死亡组（n = 66）	χ²/t/Z值	P值
年龄（x ± s，岁）	56±16	52±17	1.723^（1）	0.086
性别男	127（54.3）	40（60.6）	0.837^（3）	0.360
合并症
高血压	103（44.0）	30（45.5）	0.043^（3）	0.836
冠心病	55（23.5）	12（18.2）	0.841^（3）	0.359
糖尿病	57（24.4）	15（22.7）	0.075^（3）	0.784
COPD	44（18.8）	11（16.7）	0.157^（3）	0.692
自身免疫病	7（3.0）	4（6.1）	1.373^（3）	0.241
脑梗死	47（20.1）	13（19.7）	0.005^（3）	0.944
感染部位
肺部感染	69（29.5）	17（25.8）	0.036^（3）	0.850
腹腔感染	85（36.3）	24（36.4）	0.014^（3）	0.904
泌尿系感染	82（35.0）	23（34.8）	0.024^（3）	0.952
其他部位感染	47（20.1）	15（22.7）	0.219^（3）	0.640
APACHE Ⅱ［M（P ₂₅，P ₇₅），分］	10（8，12）	12（9，13）	-4.401^（2）	< 0.001
D-D［M（P ₂₅，P ₇₅），mg/L］	1.4（1.1，1.5）	1.8（1.5，2.1）	-9.103^（2）	< 0.001
乳酸［M（P ₂₅，P ₇₅），mg/L］	14（12，15）	29（16，35）	-8.277^（2）	< 0.001
sPECAM-1［M（P ₂₅，P ₇₅），mg/L］	69（65，71）	76（68，86）	-6.829^（2）	< 0.001

	β	SE	Wald	P值	OR	95%CI
	β	SE	Wald	P值	OR	下限	上限
D-D	0.607	0.113	28.951	< 0.001	1.836	1.471	2.290
乳酸	0.161	0.029	31.601	< 0.001	1.174	1.110	1.242
sPECAM-1	0.185	0.039	22.221	< 0.001	1.204	1.114	1.300
常量	-27.452	3.869	50.351	< 0.001	0.001

指标	Cut-off值	敏感度	特异度	AUC	95%CI
APACHEⅡ评分	11.5分	0.591	0.718	0.675	0.534 ~ 0.817
D-D	1.65 mg /L	0.636	0.949	0.863	0.768 ~ 0.958
乳酸	21.5 mg /mL	0.727	0.872	0.831	0.734 ~ 0.928
sPECAM-1	75.5 ng/mL	0.5	0.049	0.774	0.653 ~ 0.896
Combine	-	0.864	0.974	0.965	0.928 ~ 1.000

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D⁃dimer and lactic acid combined with sPECAM⁃1 in the prediction of poor prognosis in patients with sepsis⁃related disseminated intravascular coagulation

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