Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
Department of Gynecology and Obstetrics, Peking University People's Hospital, Beijing 100044, China.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241271358. doi: 10.1177/10760296241271358.
Disseminated intravascular coagulation (DIC) poses a high mortality risk, yet its exact impact remains contentious. This study investigates DIC's association with mortality in individuals with sepsis, emphasizing multiple organ function. Using data from the Peking University People's Hospital Investigation on Sepsis-Induced Coagulopathy database, we categorized patients into DIC and non-DIC groups based on DIC scores within 24 h of ICU admission (< 5 cutoff). ICU mortality was the main outcome. Initial data comparison preceded logistic regression analysis of mortality factors post-propensity score matching (PSM). Employing mediation analysis estimated direct and indirect associations. Of 549 participants, 131 were in the DIC group, with the remaining 418 in the non-DIC group. Following baseline characteristic presentation, PSM was conducted, revealing significantly higher nonplatelet sequential organ failure assessment (nonplt-SOFA) scores (6.3 ± 2.7 vs 5.0 ± 2.5, P < 0.001) and in-hospital mortality rates (47.3% vs 29.5%, P = 0.003) in the DIC group. A significant correlation between DIC and in-hospital mortality persisted (OR 2.15, 95% CI 1.29-3.59, P = 0.003), with nonplt-SOFA scores (OR 1.16, 95% CI 1.05-1.28, P = 0.004) and hemorrhage (OR 2.33, 95% CI 1.08-5.03, P = 0.032) as predictors. The overall effect size was 0.1786 (95% CI 0.0542-0.2886), comprising a direct effect size of 0.1423 (95% CI 0.0153-0.2551) and an indirect effect size of 0.0363 (95% CI 0.0034-0.0739), with approximately 20.3% of effects mediated. These findings underscore DIC's association with increased mortality risk in patients with sepsis, urging anticoagulation focus over bleeding management, with organ dysfunction assessment recommended for anticoagulant treatment efficacy.
弥散性血管内凝血 (DIC) 死亡率高，但确切影响仍存在争议。本研究探讨了 DIC 与脓毒症患者死亡率的关系，强调了多器官功能。我们利用北京大学人民医院脓毒症诱导凝血障碍数据库的数据，根据患者入住 ICU 24 小时内的 DIC 评分（< 5 分）将患者分为 DIC 组和非 DIC 组。主要观察终点为 ICU 死亡率。在倾向评分匹配（PSM）后，对死亡率的危险因素进行 logistic 回归分析前，先进行初始数据比较。采用中介分析估计直接和间接关联。在 549 名患者中，131 名患者为 DIC 组，其余 418 名患者为非 DIC 组。在展示了基线特征后，我们进行了 PSM，结果显示 DIC 组的非血小板序贯器官衰竭评估（nonplt-SOFA）评分（6.3±2.7 与 5.0±2.5，P<0.001）和住院死亡率（47.3%与 29.5%，P=0.003）明显更高。DIC 与住院死亡率之间存在显著相关性（OR 2.15，95%CI 1.29-3.59，P=0.003），非血小板 SOFA 评分（OR 1.16，95%CI 1.05-1.28，P=0.004）和出血（OR 2.33，95%CI 1.08-5.03，P=0.032）是预测因素。总效应量为 0.1786（95%CI 0.0542-0.2886），其中直接效应量为 0.1423（95%CI 0.0153-0.2551），间接效应量为 0.0363（95%CI 0.0034-0.0739），大约 20.3%的效应为中介效应。这些发现强调了 DIC 与脓毒症患者死亡率增加的关联，促使我们在治疗中更加关注抗凝，而不是出血管理，同时建议评估器官功能障碍以评估抗凝治疗效果。
