Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
Department of Emergency and Critical Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Thromb Haemost. 2019 Feb;119(2):203-212. doi: 10.1055/s-0038-1676610. Epub 2018 Dec 28.
Two different criteria for evaluating coagulopathy in sepsis were recently released: sepsis-induced coagulopathy (SIC) and sepsis-associated coagulopathy (SAC). Although both use universal haemostatic markers of platelet count and pro-thrombin time, significance and usefulness of these criteria remain unclear.
This article validates and evaluates the significance of SIC and SAC criteria compared with the International Society on Thrombosis and Haemostasis (ISTH) overt disseminated intravascular coagulation (DIC) and Japanese Association for Acute Medicine (JAAM) DIC criteria.
Clinical characteristics of patients from a nationwide Japanese cohort were classified by SIC, SAC or DIC status and relations between criteria were examined. We evaluated associations between in-hospital mortality and anticoagulant therapy according to the SIC, SAC or DIC status to clarify the significance of criteria for introducing anticoagulants. Intervention effects were analysed by Cox regression analysis adjusted by propensity scoring.
Incidences of coagulopathy diagnosed by SIC and JAAM DIC were similar, whereas those of SAC and ISTH overt DIC were about half of the former two (61.4%, 60.8% vs. 45.3%, 29.3%). Severity and mortality of all criteria were almost comparable. For validating initiation of anticoagulation, favourable effects of anticoagulant therapy were observed only in sub-sets with, and not without, coagulopathy diagnosed by all four criteria. Slight non-significant differences between anticoagulant groupings were found in ISTH overt DIC- and SAC-negative populations, suggesting that some patients even 'without' these criteria may benefit from anticoagulant therapy.
Newly developed SIC diagnostic criteria for coagulopathy may be valuable in detecting appropriate candidates for anticoagulant therapy in sepsis and a useful alternative to conventional DIC scoring systems.
最近发布了两种不同的评估脓毒症凝血障碍的标准：脓毒症诱导的凝血障碍（SIC）和脓毒症相关的凝血障碍（SAC）。尽管两者都使用血小板计数和凝血酶原时间的通用止血标志物，但这些标准的意义和用途仍不清楚。
本文验证并评估了 SIC 和 SAC 标准与国际血栓与止血学会（ISTH）显性弥漫性血管内凝血（DIC）和日本急救医学协会（JAAM）DIC 标准相比的意义。
通过 SIC、SAC 或 DIC 状态对来自全国性日本队列的患者的临床特征进行分类，并检查标准之间的关系。我们根据 SIC、SAC 或 DIC 状态评估了住院死亡率与抗凝治疗之间的关系，以明确标准在引入抗凝剂方面的意义。通过倾向评分调整的 Cox 回归分析评估干预效果。
SIC 和 JAAM DIC 诊断的凝血障碍发生率相似，而 SAC 和 ISTH 显性 DIC 的发生率则为前两者的一半左右（61.4%、60.8% vs. 45.3%、29.3%）。所有标准的严重程度和死亡率几乎相当。为了验证抗凝剂起始的有效性，仅在所有四个标准诊断为有凝血障碍的亚组中观察到抗凝治疗的有利效果，而在没有凝血障碍的亚组中则没有观察到。在 ISTH 显性 DIC-和 SAC-阴性人群中，抗凝剂分组之间存在轻微的非显著性差异，这表明即使没有这些标准，一些患者也可能受益于抗凝治疗。
新开发的 SIC 凝血障碍诊断标准可能有助于在脓毒症中检测出适合抗凝治疗的候选者，是传统 DIC 评分系统的有用替代方法。
