PDF(Pubmed)
Abstract：
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.
摘要：
弥散性血管内凝血（DIC）具有很高的死亡风险，然而，它的确切影响仍然存在争议。本研究调查了脓毒症患者DIC与死亡率的关系。强调多器官功能。利用北京大学人民医院脓毒症相关性凝血病数据库的调查数据，我们根据入住ICU24小时内的DIC评分(<5个临界值)将患者分为DIC和非DIC组.ICU死亡率是主要结果。在倾向评分匹配（PSM）后对死亡率因素进行逻辑回归分析之前进行了初始数据比较。采用中介分析估计的直接和间接关联。在549名参与者中，131人属于DIC组，其余418在非DIC组中。基线特征呈现后，进行了PSM，显示出非血小板序贯器官衰竭评估（nonplt-SOFA）评分（6.3±2.7vs5.0±2.5，P<0.001）和住院死亡率（47.3％vs29.5％，DIC组P=0.003）。DIC与住院死亡率之间存在显著相关性(OR2.15,95%CI1.29-3.59,P=0.003),以nonplt-SOFA评分(OR1.16,95%CI1.05-1.28,P=0.004)和出血(OR2.33,95%CI1.08-5.03,P=0.032)作为预测因子。总体效应大小为0.1786(95%CI0.0542-0.2886)，包括直接效应大小为0.1423(95%CI0.0153-0.2551)和间接效应大小为0.0363(95%CI0.0034-0.0739)，约有20.3%的效应介导。这些发现强调了DIC与脓毒症患者死亡风险增加的相关性。敦促将抗凝重点放在出血管理上，与器官功能障碍评估推荐抗凝治疗疗效。
