Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, MO.
Crit Care Med. 2018 May;46(5):736-742. doi: 10.1097/CCM.0000000000002997.
To assess whether sepsis-associated coagulopathy predicts hospital mortality.
Retrospective cohort study.
One-thousand three-hundred beds urban academic medical center.
Six-thousand one-hundred forty-eight consecutive patients hospitalized between January 1, 2010, and December 31, 2015.
Mild sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.2 and less than 1.4 plus platelet count less than or equal to 150,000/µL but greater than 100,000/µL; moderate sepsis-associated coagulopathy was defined with either an international normalized ratio greater than or equal to 1.4 but less than 1.6 or platelets less than or equal to 100,000/µL but greater than 80,000/µL; severe sepsis-associated coagulopathy was defined as an international normalized ratio greater than or equal to 1.6 and platelets less than or equal to 80,000/µL.
Hospital mortality increased progressively from 25.4% in patients without sepsis-associated coagulopathy to 56.1% in patients with severe sepsis-associated coagulopathy. Similarly, duration of hospitalization and ICU care increased progressively as sepsis-associated coagulopathy severity increased. Multivariable analyses showed that the presence of sepsis-associated coagulopathy, as well as sepsis-associated coagulopathy severity, was independently associated with hospital mortality regardless of adjustments made for baseline patient characteristics, hospitalization variables, and the sepsis-associated coagulopathy-cancer interaction. Odds ratios ranged from 1.33 to 2.14 for the presence of sepsis-associated coagulopathy and from 1.18 to 1.51 for sepsis-associated coagulopathy severity for predicting hospital mortality (p < 0.001 for all comparisons).
The presence of sepsis-associated coagulopathy identifies a group of patients with sepsis at higher risk for mortality. Furthermore, there is an incremental risk of mortality as the severity of sepsis-associated coagulopathy increases.
评估脓毒症相关凝血障碍是否可预测住院死亡率。
回顾性队列研究。
一家拥有 1300 张病床的城市学术医疗中心。
2010 年 1 月 1 日至 2015 年 12 月 31 日连续收治的 6148 例患者。
轻度脓毒症相关凝血障碍定义为国际标准化比值（INR）≥1.2 且＜1.4 并伴有血小板计数≤150000/µL 但＞100000/µL；中度脓毒症相关凝血障碍定义为 INR≥1.4 但＜1.6 或血小板计数≤100000/µL 但＞80000/µL；重度脓毒症相关凝血障碍定义为 INR≥1.6 且血小板计数≤80000/µL。
未发生脓毒症相关凝血障碍患者的住院死亡率为 25.4%，而发生重度脓毒症相关凝血障碍患者的住院死亡率为 56.1%，死亡率逐渐升高。同样，随着脓毒症相关凝血障碍严重程度的增加，住院时间和 ICU 治疗时间也逐渐增加。多变量分析显示，无论对患者基线特征、住院变量和脓毒症相关凝血障碍-癌症相互作用进行何种调整，脓毒症相关凝血障碍的存在以及严重程度均与住院死亡率独立相关。脓毒症相关凝血障碍存在的比值比（OR）范围为 1.33 至 2.14，脓毒症相关凝血障碍严重程度的 OR 范围为 1.18 至 1.51（所有比较的 p＜0.001）。
脓毒症相关凝血障碍的存在提示存在一组脓毒症死亡率较高的患者。此外，随着脓毒症相关凝血障碍严重程度的增加，死亡率的风险也逐渐增加。
