脓毒症相关凝血功能障碍对脓毒症患者预后的评估价值

A clinical research on relationship between sepsis-associated coagulopathy and prognosis in patients with sepsis

目的评价脓毒症相关凝血功能障碍(SAC)诊断标准预测脓毒症患者预后的价值。方法回顾性分析2014年6月至2017年6月入住东部战区总医院急诊重症监护病房(EICU)脓毒症患者的临床资料,根据入科时的国际标准化比值和血小板计数确定患者的SAC诊断,将患者分为无SAC、轻度SAC、中度SAC和重度SAC四组,记录各组患者入科时的年龄、性别、急性生理与慢性健康Ⅱ(APACHEⅡ)评分、中国弥散性血管内凝血诊断积分(CDS),基础疾病及住院时的血管活性药使用和机械通气情况,比较各组患者住院病死率、住EICU时间和住EICU费用等预后指标,使用秩相关检验SAC诊断标准和APACHEⅡ评分、CDS的相关性。结果各组患者的年龄、性别、基础疾病和住院期间使用机械通气方面差异无统计学意义(P>0.05)。无SAC、轻度SAC、中度SAC和重度SAC组APACHEⅡ评分分别为(14.3±2.8)、(15.6±2.5)、(19.2±2.1)和(22.3±3.5)。SAC严重程度越高,患者的APACHEⅡ评分及CDS越高(P<0.05),血管活性药物的使用越多(P<0.001),SAC与APACHEⅡ和CDS具有较高的相关性,相关系数分别为0.712和0.685(P<0.001),重度SAC患者具有更高的住院病死率(53.7%)、住EICU时间[(8.5±3.8) d]和EICU费用[(11.7±5.2)万元]。结论 SAC与APACHEⅡ、CDS具有良好的相关性,SAC能在一定程度上预测脓毒症患者的病情严重程度和预后。

Objective To evaluate the value of diagnostic criteria of sepsis-associated coagulopathy(SAC) to predict the prognosis of patients with sepsis.Methods The clinical data of sepsis patients who were admitted to our emergency intensive care unit(EICU) from June 2014 to June 2017 were analyzed.The diagnosis of SAC was determined according to the international standardized ratio and platelet count at the time of admission.The patients were divided into four group(no SAC,mild SAC,moderate SAC and severe SAC).The age,gender,APACHE Ⅱ score,Chinese DIC scoring,underlying disease,vasoactive drug use and mechanical ventilation during hospitalization were recorded.The prognostic indicators such as hospital mortality,EICU stay time,and EICU cost were compared.The correlation with SAC diagnostic criteria and APACHE Ⅱ scores and CDS was determined using rank correlation.Results There was no difference in age,gender,and underlying disease in each group(P>0.05).APACHE Ⅱ scores of no SAC,mild SAC,moderate SAC and severe SAC group were(14.3±2.8),(15.6±2.5),(19.2±2.1),(22.3±3.5),respectively.The higher the severity of SAC,the higher the APACHE Ⅱand CDSscoreof the patient(P<0.05),the more vasoactive drugs were used(P<0.001).SAC had a high correlation with APACHE Ⅱ and CDSwith thecorrelation coefficients 0.712 and 0.685,respectively(P<0.001).Patients with severe SAC had a higher hospital mortality rate,EICU stay time,and EICU cost [53.7%,(8.5± 3.8) daysand(11.7± 5.2) million,respectively].Conclusion SAC has a good correlation with APACHE Ⅱ and CDS.SAC can predict the severity and prognosis of patients with sepsis.