ICU脓毒症患者凝血相关参数的变化与预后关系的研究

Correlation between changes of coagulation-related parameter and prognosis in ICU patients with septic

目的探讨ICU脓毒症患者凝血相关参数的变化与预后的关系。方法选取2016年8月至2019年8月收入首都医科大学附属北京朝阳医院京西院区ICU脓毒症患者100例,依据sepsis3.0标准分为脓毒症组50例和脓毒症休克组50例,监测入院24 h和72 h血小板计数(PLT)、血小板压积(PCT)、血小板平均体积(MPV)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、凝血酶时间(TT)。记录患者入院时年龄、性别、急性生理与慢性健康状况评估(APACHEⅡ)评分、28 d生存情况等。比较脓毒症与脓毒症休克患者入院24 h和72 h凝血相关参数变化的差异,采用受试者工作特征(ROC)曲线分析凝血相关参数对脓毒症患者死亡的预测能力。结果入院24 h、72 h,脓毒症组PLT、PCT高于脓毒症休克组,MPV、PT、APTT、TT均低于脓毒症休克组,差异均有统计学意义(P<0.05)。入院24 h,APACHEⅡ≤22分组PLT、PCT高于APACHEⅡ>22分组,MPV、PT、APTT、TT均低于APACHEⅡ>22分组,差异均有统计学意义(P<0.05)。入院24 h的PLT、PCT、MPV、PT、APTT、TT的ROC曲线下面积分别为0.803、0.769、0.556、0.545、0.669、0.531,入院72 h的PLT、PCT、MPV、PT、APTT、TT的ROC曲线下面积分别为0.919、0.900、0.734、0.950、0.925、0.851,入院72 h的PT敏感度92%,特异度90.7%(P<0.001)。结论凝血相关参数的变化与脓毒症严重程度密切相关,入院72 h的PT更能对脓毒症预后有较好的预测价值。

Objective To study the relationship between coagulation-related parameters and prognosis in ICU patients with septic.Methods 100 patients with sepsis who were admitted to intensive care unit(ICU)of Beijing Chaoyang Hospital Jingxi Branch,Capital Medical University from August 2016 to August 2019 were taken as a study group.It was divided into 50 patients in sepsis group and 50 patients in septic shock group according to sepsis 3.0 criteria.Platelet count(PLT),plateletcrit(PCT),platelet mean volume(MPV),prothrombin time(PT),partial prothrombin time(APTT),thrombin time(TT),gender,age,acute physiology and chronic health evaluation(APACHEⅡ)score was monitored at 24 h and 72 h after admission,28 days survival of patients were recorded at admission.The differences in coagulation-related parameters between sepsis group and sepsis shock group were compared.The reliability of coagulation-related parameters to predict the prognosis was estimated by using receiver operating characteristic euestimated by using receiver operating characteristic(ROC)curve.Results At 24 hours and 72 hours after admission,the PLT and PCT in the sepsis group were higher than those in the septic shock group,and the mean platelet volume,prothrombin time,partial prothrombin time,and thrombin time were lower than those in the septic shock group,thes differences were statistically significant(P<0.05).At 24 hours after admission,PLT and PCT in APACHEⅡ≤22 group were higher than those in APACHEⅡ>22 group,MPV,PT,APTT and TT were lower than those in APACHEⅡ>22 group,the differences were statistically significant(P<0.05).The area under the ROC curve of PLT,PCT,MPV,PT,APTT,TT at 24 hours after admission was 0.803,0.769,0.556,0.545,0.669 and 0.531,and the area under ROC curve of 72 hour PLT,PCT,MPV,PT,APTT,TT was 0.919,0.900,0.734,0.950,0.925 and 0.851.The sensitivity and specificity of prothrombin time 72 h after admission predicting the prognosis of death were 92%and 90.7%.Conclusion The change of coagulation-related parameters is closely related to the severity of sepsis.PT at 72h after admission may be a good predictor of the prognosis of sepsis.