Department of Hematology, Qilu Hospital of Shandong University, Jinan, 250012, China.
Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, 250012, China.
Curr Med Sci. 2024 Oct;44(5):912-922. doi: 10.1007/s11596-024-2920-0. Epub 2024 Sep 17.
Coagulation abnormalities are common and prognostically significant in intensive care units (ICUs) and are associated with increased mortality. This study aimed to explore the association between the levels of coagulation markers and the risk of mortality among ICU patients with coagulation abnormalities.
This retrospective study investigated patients with coagulation abnormalities in the ICU between January 2021 and December 2022. The initial point for detecting hemostatic biomarkers due to clinical assessment of coagulation abnormalities was designated day 0. Patients were followed up for 28 days, and multivariate logistic regression analysis was utilized to identify risk factors for mortality.
Of the 451 patients analyzed, 115 died, and 336 were alive at the end of the 28-day period. Multivariate analysis revealed that elevated thrombin-antithrombin complex (TAT), tissue plasminogen activator inhibitor complex (tPAIC), prolonged prothrombin time, and thrombocytopenia were independent risk factors for mortality. For nonovert disseminated intravascular coagulation (DIC) patients, older age and thrombocytopenia were associated with increased risks of mortality, whereas elevated levels of plasmin α-plasmin inhibitor complex (PIC) were found to be independent predictors of survival. In patients with overt DIC, elevated levels of tPAIC were independently associated with increased risks of mortality. Nevertheless, thrombocytopenia was independently associated with increased risks of mortality in patients with pre-DIC.
Coagulation markers such as the TAT, tPAIC, PIC, and platelet count were significantly associated with mortality, underscoring the importance of maintaining a balance between coagulation and fibrinolysis. These findings highlight the potential for targeted therapeutic interventions based on specific coagulation markers to improve patient outcomes.
在重症监护病房（ICU）中，凝血异常很常见且具有预后意义，并与死亡率升高相关。本研究旨在探讨 ICU 中凝血异常患者的凝血标志物水平与死亡风险之间的关系。
这是一项回顾性研究，纳入了 2021 年 1 月至 2022 年 12 月 ICU 中存在凝血异常的患者。因临床评估凝血异常而首次检测止血生物标志物的时间点被定义为第 0 天。对患者进行 28 天的随访，并采用多变量逻辑回归分析来确定死亡的危险因素。
在分析的 451 例患者中，有 115 例死亡，336 例在 28 天期末存活。多变量分析显示，升高的凝血酶-抗凝血酶复合物（TAT）、组织型纤溶酶原激活物抑制剂复合物（tPAIC）、延长的凝血酶原时间和血小板减少是死亡的独立危险因素。对于非显性弥散性血管内凝血（DIC）患者，年龄较大和血小板减少与死亡风险增加相关，而升高的纤溶酶-α-纤溶酶抑制剂复合物（PIC）水平被发现是存活的独立预测因子。在显性 DIC 患者中，升高的 tPAIC 水平与死亡风险增加独立相关。然而，血小板减少与 pre-DIC 患者的死亡风险增加独立相关。
TAT、tPAIC、PIC 和血小板计数等凝血标志物与死亡率显著相关，这强调了维持凝血和纤溶平衡的重要性。这些发现提示基于特定凝血标志物进行靶向治疗干预可能改善患者结局。
