Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-Ku, Tokyo, 113-8421, Japan.
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Sci Rep. 2023 Dec 15;13(1):22502. doi: 10.1038/s41598-023-49855-y.
Disseminated intravascular coagulation (DIC) is a frequent complication in patients with sepsis and is associated with increased mortality. Anticoagulant therapy may be appropriate for certain patients with DIC, particularly those with increased disease severity and deficiency in the physiologic anticoagulant antithrombin. We retrospectively analyzed post-marketing survey data from 1562 patients with sepsis-associated DIC and antithrombin activity of 70% or less. All the patients were treated with antithrombin concentrates. Baseline sequential organ failure assessment (SOFA) score, DIC score, and antithrombin activity were assessed. Cox multivariate regression analysis, Kaplan-Meier curve analysis, and receiver operating characteristic (ROC) curve analysis were performed to evaluate the performance of variables used to assess mortality. Furthermore, a decision tree was constructed to classify the risk of 28-day mortality. COX multivariate regression analysis demonstrated a significant association of age, sex, baseline SOFA score, baseline antithrombin activity, and the presence of pneumonia or skin/soft tissue infection with increased mortality. The area under the curve of SOFA score or antithrombin activity for mortality was 0.700 and 0.614, respectively. Kaplan-Meier analysis demonstrated that mortality was significantly higher in patients with SOFA score ≥ 12 and antithrombin activity < 47%. The decision tree analysis accurately classified the risk of death into high (> 40%), medium (40%-20%), and low (< 20%) categories in 86.1% of the cohort. Twenty eight-day mortality can be strongly predicted using baseline SOFA score, antithrombin activity, infection site, age, and sex as variables in the clinical decision tree for patients with sepsis-associated disseminated intravascular coagulation (DIC).
弥散性血管内凝血（DIC）是脓毒症患者的常见并发症，与死亡率增加有关。抗凝治疗可能适用于某些 DIC 患者，特别是那些疾病严重程度增加和生理抗凝物抗凝血酶缺乏的患者。我们回顾性分析了 1562 例脓毒症相关 DIC 且抗凝血酶活性为 70%或更低的患者的上市后调查数据。所有患者均接受抗凝血酶浓缩物治疗。评估了基线序贯器官衰竭评估（SOFA）评分、DIC 评分和抗凝血酶活性。进行 Cox 多变量回归分析、Kaplan-Meier 曲线分析和受试者工作特征（ROC）曲线分析，以评估用于评估死亡率的变量的性能。此外，构建了决策树来分类 28 天死亡率的风险。COX 多变量回归分析表明，年龄、性别、基线 SOFA 评分、基线抗凝血酶活性以及肺炎或皮肤/软组织感染与死亡率增加显著相关。SOFA 评分或抗凝血酶活性对死亡率的曲线下面积分别为 0.700 和 0.614。Kaplan-Meier 分析表明，SOFA 评分≥12 和抗凝血酶活性<47%的患者死亡率显著更高。决策树分析准确地将死亡率高（>40%）、中（40%-20%）和低（<20%）风险的患者分类到 86.1%的队列中。使用基线 SOFA 评分、抗凝血酶活性、感染部位、年龄和性别作为临床决策树中脓毒症相关弥散性血管内凝血（DIC）患者的变量，可以强烈预测 28 天死亡率。
