Department of Pediatrics, University of Colorado Anschutz Medical Center and Children's Hospital Colorado, Aurora, CO.
Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Pediatr. 2020 Oct;225:198-206.e2. doi: 10.1016/j.jpeds.2020.06.022. Epub 2020 Jun 14.
To evaluate the impact of early disseminated intravascular coagulation (DIC) on illness severity in children using a database of emergency department ED encounters for children with suspected sepsis, in view of similar associations in adults.
Laboratory and clinical data were extracted from a registry of emergency department encounters of children with suspected sepsis between April 1, 2012, and June 26, 2017. International Society of Thrombosis and Hemostasis DIC scores were calculated from laboratory values obtained within 24 hours of emergency department admission. Univariate logistic regression, multivariable logistic regression, and Cox regression were used to assess the influence of DIC scores on vasopressor use (primary outcome), mortality, ventilator requirement, pediatric intensive care unit admission, and hospital duration (secondary outcomes). The optimal DIC score cutoff for outcome prediction was determined.
Of 1653 eligible patients, 284 had DIC scores within 24 hours, including 92 who required vasopressors and 23 who died within 1 year. An initial DIC score of ≥3 was the most sensitive and specific DIC score for predicting adverse outcomes. Those with a DIC score of ≥3 vs <3 had increased odds of vasopressor use in both univariate (OR, 4.48; 95% CI, 2.63-7.62; P < .001) and multivariable (OR, 3.78; 95% CI, 1.82-7.85; P < .001) analyses. Additionally, those with a DIC score of ≥3 vs <3 had increased 1-year mortality with a hazard ratio of 3.55 (95% CI, 1.46-8.64; P = .005).
A DIC score of ≥3 was an independent predictor for both vasopressor use and mortality in this pediatric cohort, distinct from the adult overt DIC score cutoff of ≥5.
鉴于成人弥散性血管内凝血（DIC）与疾病严重程度存在类似关联，本研究旨在通过疑似脓毒症儿童急诊科就诊数据库评估早期弥散性血管内凝血（DIC）对疾病严重程度的影响。
本研究从 2012 年 4 月 1 日至 2017 年 6 月 26 日疑似脓毒症儿童急诊科就诊登记中提取了实验室和临床数据。根据急诊科就诊 24 小时内获得的实验室值计算国际血栓与止血学会 DIC 评分。采用单因素逻辑回归、多因素逻辑回归和 Cox 回归评估 DIC 评分对血管加压素使用（主要结局）、死亡率、呼吸机需求、儿科重症监护病房入院和住院时间（次要结局）的影响。确定预测结果的最佳 DIC 评分截断值。
在 1653 名符合条件的患者中，284 名患者在 24 小时内出现 DIC 评分，其中 92 名患者需要血管加压素，23 名患者在 1 年内死亡。初始 DIC 评分≥3 是预测不良结局最敏感和特异的 DIC 评分。与 DIC 评分＜3 的患者相比，DIC 评分≥3 的患者在单因素（比值比，4.48；95%置信区间，2.63-7.62；P＜.001）和多因素（比值比，3.78；95%置信区间，1.82-7.85；P＜.001）分析中均具有更高的血管加压素使用几率。此外，与 DIC 评分＜3 的患者相比，DIC 评分≥3 的患者 1 年死亡率更高，风险比为 3.55（95%置信区间，1.46-8.64；P=.005）。
在该儿科队列中，DIC 评分≥3 是血管加压素使用和死亡率的独立预测因素，与成人显性 DIC 评分截断值≥5 不同。
