Zhao Xue-Song, Meng Zhao-Li, Zhang Tuo, Yang Hong-Na, Zhang Ji-Cheng, Fang Wei, Wang Chun-Ting, Chen Man
Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
Department of Critical Care Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, China.
Curr Med Sci. 2023 Feb;43(1):86-92. doi: 10.1007/s11596-022-2689-y. Epub 2023 Feb 8.
Despite the recent advances in diagnosis and treatment, sepsis continues to lead to high morbidity and mortality. Early diagnosis and prompt treatment are essential to save lives. However, most biomarkers can only help to diagnose sepsis, but cannot predict the development of septic shock in high-risk patients. The present study determined whether the combined measurement of procalcitonin (PCT), thromboelastography (TEG) and platelet (PLT) count can predict the development of septic shock.
A retrospective study was conducted on 175 septic patients who were admitted to the intensive care unit between January 2017 and February 2021. These patients were divided into two groups: 73 patients who developed septic shock were assigned to the septic shock group, while the remaining 102 patients were assigned to the sepsis group. Then, the demographic, clinical and laboratory data were recorded, and the predictive values of PCT, TEG and PLT count for the development of septic shock were analyzed.
Compared to the sepsis group, the septic shock group had statistically lower PLT count and TEG measurements in the R value, K value, α angle, maximum amplitude, and coagulation index, but had longer prothrombin time (DT), longer activated partial thromboplastin time (APTT), and higher PCT levels. Furthermore, the Sequential Organ Failure Assessment (SOFA) score was higher in the septic shock group. The multivariate logistic regression analysis revealed that PCT, TEG and PLT count were associated with the development of septic shock. The area under the curve analysis revealed that the combined measurement of PCT, TEG and PLT count can be used to predict the development of septic shock with higher accuracy, when compared to individual measurements.
The combined measurement of PCT, TEG and PLT count is a novel approach to predict the development of septic shock in high-risk patients.
尽管近期在诊断和治疗方面取得了进展，但脓毒症仍然导致高发病率和死亡率。早期诊断和及时治疗对于挽救生命至关重要。然而，大多数生物标志物只能帮助诊断脓毒症，却无法预测高危患者发生感染性休克的情况。本研究旨在确定降钙素原（PCT）、血栓弹力图（TEG）和血小板（PLT）计数的联合检测是否能够预测感染性休克的发生。
对2017年1月至2021年2月期间入住重症监护病房的175例脓毒症患者进行回顾性研究。这些患者被分为两组：73例发生感染性休克的患者被分配到感染性休克组，其余102例患者被分配到脓毒症组。然后，记录人口统计学、临床和实验室数据，并分析PCT、TEG和PLT计数对感染性休克发生的预测价值。
与脓毒症组相比，感染性休克组的PLT计数以及TEG测量中的R值、K值、α角、最大振幅和凝血指数在统计学上更低，但凝血酶原时间（DT）更长、活化部分凝血活酶时间（APTT）更长且PCT水平更高。此外，感染性休克组的序贯器官衰竭评估（SOFA）评分更高。多因素逻辑回归分析显示，PCT、TEG和PLT计数与感染性休克的发生相关。曲线下面积分析显示，与单独测量相比，PCT、TEG和PLT计数的联合检测可用于更准确地预测感染性休克的发生。
PCT、TEG和PLT计数的联合检测是预测高危患者感染性休克发生的一种新方法。
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