Bakhtiari Kamran, Meijers Joost C M, de Jonge Evert, Levi Marcel
Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, The Netherlands.
Crit Care Med. 2004 Dec;32(12):2416-21. doi: 10.1097/01.ccm.0000147769.07699.e3.
A diagnosis of disseminated intravascular coagulation (DIC) is hampered by the lack of an accurate diagnostic test. Based on the retrospective analysis of studies in patients with DIC, a scoring system (0-8 points) using simple and readily available routine laboratory tests has been proposed. The aim of this study was to prospectively validate this scoring system and assess its feasibility, sensitivity, and specificity in a consecutive series of intensive care patients.
Prospective cohort of intensive care patients.
Adult intensive care unit in a tertiary academic center.
Consecutive patients with a clinical suspicion of disseminated intravascular coagulation.
Patients were followed during their admission to the intensive care unit, and the DIC score was calculated every 48 hrs and compared with a "gold standard" based on expert opinion. In addition, an activated partial thromboplastin time (aPTT) waveform analysis, which has been reported to be a good predictor for the absence or presence of DIC, was performed.
We analyzed 660 samples from 217 consecutive patients. The prevalence of DIC was 34%. There was a strong correlation between an increasing DIC score and 28-day mortality (for each 1-point increment in the DIC score, the odds ratio for mortality was 1.25). The sensitivity of the DIC score was 91% and the specificity 97%. An abnormal aPTT waveform was seen in 32% of patients and correlated well with the presence of DIC (sensitivity 88%, specificity 97%). In 19% of patients, the aPTT waveform-based diagnosis of DIC preceded the diagnosis based on the scoring system.
A diagnosis of DIC based on a simple scoring system, using widely available routine coagulation tests, is sufficiently accurate to make or reject a diagnosis of DIC in intensive care patients with a clinical suspicion of this condition. An aPTT waveform analysis is an interesting and promising tool to assist in the diagnostic management of DIC.
弥散性血管内凝血（DIC）的诊断因缺乏准确的诊断试验而受到阻碍。基于对DIC患者研究的回顾性分析，有人提出了一种使用简单且易于获得的常规实验室检查的评分系统（0 - 8分）。本研究的目的是前瞻性地验证该评分系统，并评估其在一系列连续的重症监护患者中的可行性、敏感性和特异性。
重症监护患者的前瞻性队列研究。
一所三级学术中心的成人重症监护病房。
临床怀疑患有弥散性血管内凝血的连续患者。
患者在入住重症监护病房期间接受随访，每48小时计算一次DIC评分，并与基于专家意见的“金标准”进行比较。此外，还进行了活化部分凝血活酶时间（aPTT）波形分析，据报道该分析是DIC存在与否的良好预测指标。
我们分析了217例连续患者的660份样本。DIC的患病率为34%。DIC评分增加与28天死亡率之间存在很强的相关性（DIC评分每增加1分，死亡比值比为1.25）。DIC评分的敏感性为91%，特异性为97%。32%的患者出现异常aPTT波形，且与DIC的存在密切相关（敏感性88%，特异性97%）。在19%的患者中，基于aPTT波形的DIC诊断先于基于评分系统的诊断。
基于简单评分系统、使用广泛可用的常规凝血试验进行DIC诊断，对于临床怀疑患有该疾病的重症监护患者来说，足以准确地做出或排除DIC诊断。aPTT波形分析是协助DIC诊断管理的一种有趣且有前景的工具。
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