PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 (P<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, P<0.001). Favorable effects of anticoagulant therapy were observed in SIC (adjusted hazard ratio [HR]=0.216, 95% confidence interval [95% CI]: 0.060-0.783, P=0.018) and SAC (adjusted HR=0.146, 95% CI: 0.041-0.513, P=0.003).
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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 (P<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, P<0.001). Favorable effects of anticoagulant therapy were observed in SIC (adjusted hazard ratio [HR]=0.216, 95% confidence interval [95% CI]: 0.060-0.783, P=0.018) and SAC (adjusted HR=0.146, 95% CI: 0.041-0.513, P=0.003).
CONCLUSIONS: 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.
摘要：
背景：弥散性血管内凝血（DIC）与脓毒症患者死亡率增加相关。在这项研究中,我们旨在评估脓毒症诱导的凝血功能障碍(SIC)和脓毒症相关凝血功能障碍(SAC)标准在确定脓毒症患者的显性DIC和DIC前状态方面的临床能力.
方法：回顾性收集了2018年7月至2022年12月419例脓毒症患者的数据。评估SIC和SAC的性能以在第1、3、7或14天鉴定明显的DIC。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评分的总和，以确定DIC前的能力。评估第1天的SIC或SAC状态作为抗凝剂引发的DIC前指标。
结果：在第1天，根据明显的DIC，凝血病的发生率，SIC和SAC标准为11.7%，22.0%和31.5%，分别。从第1天到第14天，SIC识别显性DIC的特异性显着高于SAC标准（P<0.05）。在第1天，与SIC或SAC状态相比，截止值>3的SIC评分在识别DIC前方面具有显着更高的灵敏度（72.00％）和曲线下面积（AUC）（0.69）（灵敏度：SIC状态44.00％，SAC状态52.00%；AUC：SIC状态0.62，SAC状态0.61）。与SAC相比，第1天和第3天的SIC分数之和具有更高的AUC值（0.79vs.0.69,P<0.001)。在SIC（调整后的风险比[HR]=0.216，95％置信区间[95％CI]：0.060-0.783，P=0.018）和SAC（调整后的HR=0.146，95％CI：0.041-0.513，P=0.003）中观察到了抗凝治疗的有利效果。
结论：SIC和SAC似乎对预测明显的DIC有价值。第1天和第3天的SIC分数的总和具有帮助识别DIC前的潜力。
方法：回顾性收集了2018年7月至2022年12月419例脓毒症患者的数据。评估SIC和SAC的性能以在第1、3、7或14天鉴定明显的DIC。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评分的总和，以确定DIC前的能力。评估第1天的SIC或SAC状态作为抗凝剂引发的DIC前指标。
结果：在第1天，根据明显的DIC，凝血病的发生率，SIC和SAC标准为11.7%，22.0%和31.5%，分别。从第1天到第14天，SIC识别显性DIC的特异性显着高于SAC标准（P<0.05）。在第1天，与SIC或SAC状态相比，截止值>3的SIC评分在识别DIC前方面具有显着更高的灵敏度（72.00％）和曲线下面积（AUC）（0.69）（灵敏度：SIC状态44.00％，SAC状态52.00%；AUC：SIC状态0.62，SAC状态0.61）。与SAC相比，第1天和第3天的SIC分数之和具有更高的AUC值（0.79vs.0.69,P<0.001)。在SIC（调整后的风险比[HR]=0.216，95％置信区间[95％CI]：0.060-0.783，P=0.018）和SAC（调整后的HR=0.146，95％CI：0.041-0.513，P=0.003）中观察到了抗凝治疗的有利效果。
结论：SIC和SAC似乎对预测明显的DIC有价值。第1天和第3天的SIC分数的总和具有帮助识别DIC前的潜力。
