Zhao Huixin, Dong Yiming, Wang Sijia, Shen Jiayuan, Song Zhenju, Xue Mingming, Shao Mian
Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
World J Emerg Med. 2024;15(3):190-196. doi: 10.5847/wjem.j.1920-8642.2024.041.
Disseminated intravascular coagulation (DIC) is associated with increased mortality in sepsis patients. In this study, we aimed to assess the clinical ability of sepsis-induced coagulopathy (SIC) and sepsis-associated coagulopathy (SAC) criteria in identifying overt-DIC and pre-DIC status in sepsis patients.
Data from 419 sepsis patients were retrospectively collected from July 2018 to December 2022. The performances of the SIC and SAC were assessed to identify overt-DIC on days 1, 3, 7, or 14. The SIC status or SIC score on day 1, the SAC status or SAC score on day 1, and the sum of the SIC or SAC scores on days 1 and 3 were compared in terms of their ability to identify pre-DIC. The SIC or SAC status on day 1 was evaluated as a pre-DIC indicator for anticoagulant initiation.
On day 1, the incidences of coagulopathy according to overt-DIC, SIC and SAC criteria were 11.7%, 22.0% and 31.5%, respectively. The specificity of SIC for identifying overt-DIC was significantly higher than that of the SAC criteria from day 1 to day 14 (<0.05). On day 1, the SIC score with a cut-off value > 3 had a significantly higher sensitivity (72.00%) and area under the curve (AUC) (0.69) in identifying pre-DIC than did the SIC or SAC status (sensitivity: SIC status 44.00%, SAC status 52.00%; AUC: SIC status 0.62, SAC status 0.61). The sum of the SIC scores on days 1 and 3 had a higher AUC value for identifying the pre-DIC state than that of SAC (0.79 vs. 0.69, <0.001). Favorable effects of anticoagulant therapy were observed in SIC (adjusted hazard ratio []=0.216, 95% confidence interval [95% ]: 0.060-0.783, =0.018) and SAC (adjusted =0.146, 95% : 0.041-0.513, =0.003).
The SIC and SAC seem to be valuable for predicting overt-DIC. The sum of SIC scores on days 1 and 3 has the potential to help identify pre-DIC.
弥散性血管内凝血（DIC）与脓毒症患者死亡率增加相关。在本研究中，我们旨在评估脓毒症诱导的凝血病（SIC）和脓毒症相关凝血病（SAC）标准在识别脓毒症患者显性DIC和前期DIC状态方面的临床能力。
回顾性收集2018年7月至2022年12月期间419例脓毒症患者的数据。评估SIC和SAC在第1、3、7或14天识别显性DIC的性能。比较第1天的SIC状态或SIC评分、第1天的SAC状态或SAC评分以及第1天和第3天的SIC或SAC评分总和识别前期DIC的能力。将第1天的SIC或SAC状态评估为启动抗凝治疗的前期DIC指标。
第1天，根据显性DIC、SIC和SAC标准，凝血病的发生率分别为11.7%、22.0%和31.5%。从第1天到第14天，SIC识别显性DIC的特异性显著高于SAC标准（<0.05）。第1天，临界值>3的SIC评分在识别前期DIC方面的敏感性（72.00%）和曲线下面积（AUC）（0.69）显著高于SIC或SAC状态（敏感性：SIC状态44.00%，SAC状态52.00%；AUC：SIC状态0.62，SAC状态0.61）。第1天和第3天的SIC评分总和在识别前期DIC状态方面的AUC值高于SAC（0.79对0.69，<0.001）。在SIC（调整后风险比[]=0.216，95%置信区间[95%]：0.060 - 0.783，=0.018）和SAC（调整后=0.146, 95%：0.041 - 0.513，=0.003）中观察到抗凝治疗的有益效果。
SIC和SAC似乎对预测显性DIC有价值。第1天和第3天的SIC评分总和有可能有助于识别前期DIC。
