Xie Zhijie, Zhu Suijun, Wang Jun, Zhang Min, Lv Xuan, Ma Yijun, Shan Hua, Zhong Yinjun
Master of Medicine, The First People's Hospital of Linping District, Department of Neurosurgery, China.
Bachelor of Medicine, The First People's Hospital of Linping District, Department of Neurosurgery, China.
Heliyon. 2024 Jul 14;10(14):e34644. doi: 10.1016/j.heliyon.2024.e34644. eCollection 2024 Jul 30.
Coagulopathy score has been applied as a new prognostic indicator for sepsis, heart failure and acute respiratory failure. However, its ability to forecast intensive care unit (ICU) mortality in patients with an acute cerebral hemorrhage (ICH) has not been assessed. The purpose of this study was to clarify the relationship between ICU mortality and early coagulation problem score.
Data from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.0) database were used in this retrospective cohort analysis. The association between the coagulation disorder score and ICU mortality was examined using multivariate logistic regression. Furthermore, the impact of additional variables on the results was investigated by a subgroup analysis.
3174 patients (57.3 % male) were enrolled in total. The ICU mortality reached 18.2 %. After adjusting for potential confounders, the ICU mortality of patients rose with the increase of coagulation disorder score. The ROC curve revealed the predictive accuracy of coagulation dysfunction score to mortality in patients with ICU. The coagulation disorder score had a lower AUC value (0.601, P < 0.001) than the SAPSII(AUCs of 0.745[95 % CI, 0.730-0.761]) and the combined indicators(AUCs of 0.752[95 % CI, 0.737-0.767]), but larger than single indicators platelet, INR and APTT. In the subgroup analysis, most subgroups showed no significant interaction, but only age showed significant interaction in the adjusted model.
The coagulopathy score and ICU mortality were found to be strongly positively correlated in this study, and its ability to predict ICU mortality was better than that of a single measure (platelet, INR, or APTT), but worse than that of the SAPSII score, GCS system.
凝血功能障碍评分已被用作脓毒症、心力衰竭和急性呼吸衰竭的一种新的预后指标。然而，其预测急性脑出血（ICH）患者重症监护病房（ICU）死亡率的能力尚未得到评估。本研究的目的是阐明ICU死亡率与早期凝血问题评分之间的关系。
本回顾性队列分析使用了重症监护医学信息集市（MIMIC-IV）（v2.0）数据库的数据。采用多因素逻辑回归分析凝血功能障碍评分与ICU死亡率之间的关联。此外，通过亚组分析研究其他变量对结果的影响。
共纳入3174例患者（男性占57.3%）。ICU死亡率达18.2%。在对潜在混杂因素进行校正后，患者的ICU死亡率随凝血功能障碍评分的增加而升高。ROC曲线显示了凝血功能障碍评分对ICU患者死亡率的预测准确性。凝血功能障碍评分的AUC值（0.601，P<0.001）低于序贯器官衰竭评估（SOFA）评分（AUC为0.745[95%CI，0.730-0.761]）和联合指标（AUC为0.752[95%CI，0.737-0.767]），但高于单一指标血小板、国际标准化比值（INR）和活化部分凝血活酶时间（APTT）。在亚组分析中，大多数亚组未显示出显著的交互作用，但仅年龄在调整模型中显示出显著的交互作用。
本研究发现凝血功能障碍评分与ICU死亡率呈强正相关，其预测ICU死亡率的能力优于单一指标（血小板、INR或APTT），但不如SOFA评分、格拉斯哥昏迷量表（GCS）系统。
