Wada Takeshi, Gando Satoshi, Ono Yuichi, Maekawa Kunihiko, Katabami Kenichi, Hayakawa Mineji, Sawamura Atsushi
Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638 Japan.
Thromb J. 2016 Sep 21;14:43. doi: 10.1186/s12959-016-0116-y. eCollection 2016.
We tested the hypothesis that disseminated intravascular coagulation (DIC) during the early phase of post-cardiopulmonary resuscitation (CPR) is associated with systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS) and affects the outcome of out-of-hospital cardiac arrest (OHCA) patients.
A review of the computer-based medical records of OHCA patients was retrospectively conducted and included 388 patients who were divided into DIC and non-DIC patients based on the Japanese Association for Acute Medicine DIC diagnostic criteria. DIC patients were subdivided into two groups: those with and without hyperfibrinolysis. Pre-hospital factors, platelet count, coagulation and fibrinolysis markers and lactate levels within 24 h after resuscitation were evaluated. The outcome measure was all-cause hospital mortality.
DIC patients exhibited lower platelet counts, prolonged prothrombin time, decreased levels of fibrinogen and antithrombin associated with increased fibrinolysis than those without DIC. DIC patients more frequently developed SIRS and MODS, followed by worse outcomes than non-DIC patients. The same changes were observed in DIC patients with hyperfibrinolysis who showed a higher prevalence of MODS, leading to worse outcome than those without hyperfibrinolysis. Logistic regression analyses showed that lactate levels predicted hyperfibrinolysis and DIC is an independent predictor of patient death. Survival probabilities of DIC patients during hospital stay were significantly lower than non-DIC patients. The area under the receiver operating characteristic curve of DIC for the prediction of death was 0.704.
The fibrinolytic phenotype of DIC during the early phase of post-CPR more frequently results in SIRS and MODS, especially in patients with hyperfibrinolysis, and affects the outcome of OHCA patients.
我们检验了这样一个假设，即心肺复苏（CPR）早期的弥散性血管内凝血（DIC）与全身炎症反应综合征（SIRS）、多器官功能障碍综合征（MODS）相关，并影响院外心脏骤停（OHCA）患者的预后。
对OHCA患者基于计算机的医疗记录进行回顾性分析，纳入388例患者，根据日本急性医学协会的DIC诊断标准将其分为DIC组和非DIC组。DIC患者再细分为两组：有高纤溶和无高纤溶的患者。评估复苏后24小时内的院前因素、血小板计数、凝血和纤溶标志物以及乳酸水平。观察指标为全因住院死亡率。
与无DIC的患者相比，DIC患者血小板计数更低、凝血酶原时间延长、纤维蛋白原和抗凝血酶水平降低，同时纤溶增加。DIC患者更易发生SIRS和MODS，其预后比非DIC患者更差。在有高纤溶的DIC患者中也观察到同样的变化，这些患者MODS的发生率更高，导致的预后比无高纤溶的患者更差。逻辑回归分析显示，乳酸水平可预测高纤溶，而DIC是患者死亡的独立预测因素。DIC患者住院期间的生存概率显著低于非DIC患者。DIC预测死亡的受试者工作特征曲线下面积为0.704。
CPR后早期DIC的纤溶表型更常导致SIRS和MODS，尤其是在有高纤溶的患者中，并影响OHCA患者的预后。
