Emergency and Critical Care Center, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
Emergency and Critical Care Center, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
Thromb Res. 2020 Aug;192:116-121. doi: 10.1016/j.thromres.2020.05.009. Epub 2020 May 11.
Disseminated intravascular coagulation (DIC) often occurs with sepsis. A scoring system has been used for the diagnosis of DIC, but the system included at least 4 parameters. The purpose of this study was to propose a simple set of DIC criteria with coagulation-fibrinolysis markers (CFMs).
Patients with ≥2 signs of systemic inflammatory response syndrome and a quick Sequential Organ Failure Assessment score ≥ 2 points were investigated. All blood samples were collected on Days 0, 1, 3, and 7. Cutoff values of CFMs were calculated by receiver operating curve analysis. Positive predictive values (PPVs) and negative predictive values (NPVs) for the Japanese Association for Acute Medicine (JAAM) DIC criteria were evaluated by pairing the markers. Differences were analyzed by the Mann-Whitney U test, Kruskal-Wallis test, and the log-rank test.
A total of 107 patients were enrolled. The cutoff values of soluble fibrin (SF), protein C (PC), and plasminogen activator inhibitor (PAI)-1 were 48 μg/mL, 42%, and 71 ng/mL according to the International Society of Thrombosis and Hemostasis DIC criteria. The PPV of the severe SFxPC group was 100% for the JAAM DIC criteria, excluding Day 0.
Cutoff values of SF over 48 μg/mL and PC <42% could almost definitely identify JAAM DIC.
弥散性血管内凝血（DIC）常发生在脓毒症中。已经使用评分系统来诊断 DIC，但该系统包括至少 4 个参数。本研究旨在提出一种简单的 DIC 标准，其中包括凝血-纤溶标志物（CFMs）。
研究对象为至少有 2 项全身炎症反应综合征体征和快速序贯器官衰竭评估（SOFA）评分≥2 分的患者。所有血液样本均在第 0、1、3 和 7 天采集。通过接收者操作特征曲线分析计算 CFMs 的临界值。通过配对标志物评估日本急性医学协会（JAAM）DIC 标准的阳性预测值（PPV）和阴性预测值（NPV）。差异分析采用 Mann-Whitney U 检验、Kruskal-Wallis 检验和对数秩检验。
共纳入 107 例患者。根据国际血栓形成和止血协会 DIC 标准，可溶性纤维蛋白（SF）、蛋白 C（PC）和纤溶酶原激活物抑制剂（PAI）-1 的临界值分别为 48μg/mL、42%和 71ng/mL。SFxPC 严重组的 JAAM DIC 标准的 PPV 为 100%，排除第 0 天。
SF 超过 48μg/mL 和 PC<42%的临界值几乎可以确定 JAAM DIC。
