Zhang Jing, Du Hui-Min, Cheng Ming-Xiang, He Fa-Ming, Niu Bai-Lin
Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
World J Clin Cases. 2021 Sep 6;9(25):7405-7416. doi: 10.12998/wjcc.v9.i25.7405.
Currently, there is a lack of sepsis screening tools that can be widely used worldwide. Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms, which usually rely less on screening tools.
To investigate the efficiency of the international normalized ratio (INR) for the early rapid recognition of adult nonpulmonary infectious sepsis.
This is a prospective observational study. A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria. Commonly used clinical indicators, such as white blood cell, neutrophil count, lymphocyte count, neutrophil-lymphocyte count ratio (NLCR), platelets (PLT), prothrombin time, INR, activated partial thromboplastin time, and quick Sequential "Sepsis-related" Organ Failure Assessment (qSOFA) scores were recorded within 24 h after admission. The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis, Spearman correlation, and receiver operating characteristic curve analysis.
The INR value of the sepsis group was significantly higher than that of the nonsepsis group. INR has superior diagnostic efficacy for sepsis, with an area under the curve value of 0.918, when those preexisting diseases which significantly affect coagulation function were excluded. The diagnostic efficacy of the INR was more significant than that of NLCR, PLT, and qSOFA ( < 0.05). Moreover, INR levels of 1.17, 1.20, and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories: low, medium and high risk, respectively.
The INR is a promising and easily available biomarker for diagnosis, and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis. When its value is higher than the optimal cutoff value (1.22), high vigilance is required for adult nonpulmonary infectious sepsis.
目前，全球缺乏可广泛应用的脓毒症筛查工具。由于其明显的症状，肺部脓毒症可能会引起医生足够的关注，而这些症状通常较少依赖筛查工具。
探讨国际标准化比值（INR）对成人非肺部感染性脓毒症早期快速识别的效率。
这是一项前瞻性观察性研究。根据相关纳入和排除标准，共纳入108例脓毒症患者和106例非脓毒症患者。记录入院后24小时内常用的临床指标，如白细胞、中性粒细胞计数、淋巴细胞计数、中性粒细胞与淋巴细胞计数比值（NLCR）、血小板（PLT）、凝血酶原时间、INR、活化部分凝血活酶时间以及快速序贯器官衰竭评估（qSOFA）评分。通过多因素逻辑回归分析、Spearman相关性分析和受试者工作特征曲线分析，对这些临床指标的诊断性能进行分析和比较。
脓毒症组的INR值显著高于非脓毒症组。排除那些显著影响凝血功能的既往疾病后，INR对脓毒症具有较高的诊断效能，曲线下面积值为0.918。INR的诊断效能比NLCR、PLT和qSOFA更显著（P<0.05）。此外，INR水平为1.17、1.20和1.22可分别将非肺部感染性脓毒症的相对风险分为低、中、高三个类别。
INR是一种有前景且易于获得的诊断生物标志物，可作为成人非肺部感染性脓毒症早期筛查的指标之一。当其值高于最佳临界值（1.22）时，需对成人非肺部感染性脓毒症保持高度警惕。
