重症外科患者的抗凝血酶III水平：它们与静脉血栓栓塞症有关吗？
Antithrombin III levels in critically ill surgical patients: do they correlate with VTE?
作者信息
Bhatti Umar F, Dhillon Navpreet K, Mason Russell, Wang Andrew, Hashim Yassar M, Barmparas Galinos, Ley Eric J
机构信息
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.
出版信息
Trauma Surg Acute Care Open. 2023 Jun 14;8(1):e001009. doi: 10.1136/tsaco-2022-001009. eCollection 2023.
OBJECTIVE
Antithrombin III (ATIII) deficiency may result from hereditary or acquired reduction in ATIII levels and is associated with an increase in venous thromboembolism (VTE) in the general population. VTE is a potentially preventable complication in the critically ill surgical patients. The objective of this study was to evaluate the relation between ATIII levels and VTE in surgical intensive care unit (SICU) patients.
METHODS
All patients admitted to the SICU from January 2017 to April 2018 who had ATIII levels drawn were included in the study. An ATIII level below 80% of normal was considered low. The rate of VTE during the same admission was compared among patients with normal and low levels of ATIII. Prolonged length of stay (LOS >10 days) and mortality were also measured.
RESULTS
Of the 227 patients included, 59.9% were male. The median age was 60 years. Overall, 66.9% of patients had low ATIII levels. Trauma patients had a higher rate of normal ATIII levels, whereas those weighing more than 100 kg had a higher rate of low ATIII levels. Patients with low ATIII levels had higher VTE rates compared with those with normal ATIII levels (28.9% vs. 16%, p=0.04). Patients with low ATIII levels also had prolonged LOS (76.3% vs. 60%, p=0.01) and increased mortality (21.7% vs. 6.7%, p<0.01). Trauma patients with VTE were more likely to have normal ATIII levels (38.5% in low ATIII cohort vs. 61.5% VTE in normal ATIII cohort, p<0.01).
CONCLUSION
Critically ill surgical patients with low ATIII levels have higher incidence of VTE, longer LOS, and higher mortality. In contrast, critically ill trauma patients may have high incidence of VTE even with normal ATIII levels.
LEVEL OF EVIDENCE
III.
目的
抗凝血酶III（ATIII）缺乏可能源于遗传性或后天性ATIII水平降低，且与普通人群静脉血栓栓塞症（VTE）发生率增加相关。VTE是重症外科患者中一种潜在可预防的并发症。本研究的目的是评估外科重症监护病房（SICU）患者中ATIII水平与VTE之间的关系。
方法
纳入2017年1月至2018年4月入住SICU且检测了ATIII水平的所有患者。ATIII水平低于正常水平的80%被视为偏低。比较ATIII水平正常和偏低的患者在同一住院期间的VTE发生率。还测量了住院时间延长（住院时间>10天）和死亡率。
结果
纳入的227例患者中，59.9%为男性。中位年龄为60岁。总体而言，66.9%的患者ATIII水平偏低。创伤患者ATIII水平正常的比例较高，而体重超过100 kg的患者ATIII水平偏低的比例较高。与ATIII水平正常的患者相比，ATIII水平偏低的患者VTE发生率更高（28.9%对16%，p = 0.04）。ATIII水平偏低的患者住院时间也延长（76.3%对60%，p = 0.01），死亡率增加（21.7%对6.7%，p<0.01）。发生VTE的创伤患者更可能ATIII水平正常（ATIII水平偏低组中为38.5%，ATIII水平正常组中VTE患者为61.5%，p<0.01）。
结论
ATIII水平偏低的重症外科患者VTE发生率更高、住院时间更长且死亡率更高。相比之下，即使ATIII水平正常，重症创伤患者VTE发生率也可能较高。
证据级别
III级
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