Iba Toshiaki, Nisio Marcello Di, Levy Jerrold H, Kitamura Naoya, Thachil Jecko
Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Medicine and Ageing Sciences, University G D'Annunzio of Chieti-Pescara, Chieti, Italy.
BMJ Open. 2017 Sep 27;7(9):e017046. doi: 10.1136/bmjopen-2017-017046.
Recent clinical studies have shown that anticoagulant therapy might be effective only in specific at-risk subgroups of patients with sepsis and coagulation dysfunction. The definition of sepsis was recently modified, and as such, old scoring systems may no longer be appropriate for the diagnosis of sepsis-associated coagulopathy. The aim of this study was to evaluate prognostic factors in patients diagnosed with sepsis and coagulopathy according to the new sepsis definition and assess their accuracy in comparison with existing models.
Retrospective analysis of the nationwide survey for recombinant human soluble thrombomodulin.
General emergency and critical care centres in secondary and tertiary care hospitals.
We evaluated the prognostic value of the newly proposed diagnostic criteria for sepsis-induced coagulopathy (SIC). A total of 1498 Japanese patients with sepsis and coagulopathy complications who were treated with recombinant thrombomodulin were analysed in this study.
The platelet count, prothrombin time (PT) ratio, fibrinogen/fibrin degradation products, systemic inflammatory response syndrome score and Sequential Organ Failure Assessment (SOFA) score obtained just before the start of treatment were examined in relation to the 28-day mortality rate.
The platelet count, PT ratio and total SOFA were independent predictors of a fatal outcome in a logistic regression model. A SIC score was defined using the three above-mentioned variables with a positivity threshold of 4 points or more. The SIC score predicted higher 28-day mortality rate compared with the current Japanese Association for Acute Medicine-disseminated intravascular coagulation score (38.4%vs34.7%).
The SIC score is based on readily available parameters, is easy to calculate and has a high predictive value for 28-day mortality. Future studies are warranted to evaluate whether the SIC score may guide the decision to initiate anticoagulant therapy.
近期临床研究表明，抗凝治疗可能仅对脓毒症和凝血功能障碍患者的特定高危亚组有效。脓毒症的定义最近有所修改，因此，旧的评分系统可能不再适用于脓毒症相关凝血病的诊断。本研究的目的是根据新的脓毒症定义评估诊断为脓毒症和凝血病患者的预后因素，并与现有模型比较评估其准确性。
对全国重组人可溶性血栓调节蛋白调查进行回顾性分析。
二级和三级护理医院的普通急诊和重症监护中心。
我们评估了新提出的脓毒症诱导凝血病（SIC）诊断标准的预后价值。本研究共分析了1498例接受重组血栓调节蛋白治疗的日本脓毒症和凝血病并发症患者。
在开始治疗前即刻获得的血小板计数、凝血酶原时间（PT）比值、纤维蛋白原/纤维蛋白降解产物、全身炎症反应综合征评分和序贯器官衰竭评估（SOFA）评分与28天死亡率相关。
在逻辑回归模型中，血小板计数、PT比值和总SOFA是致命结局的独立预测因素。使用上述三个变量定义SIC评分，阳性阈值为4分或更高。与目前日本急性医学协会传播的血管内凝血评分相比，SIC评分预测的28天死亡率更高（38.4%对34.7%）。
SIC评分基于易于获得的参数，易于计算，对28天死亡率具有较高的预测价值。未来有必要进行研究以评估SIC评分是否可指导启动抗凝治疗的决策。
