早期黏弹性凝血功能对热射病患者凝血功能障碍发生的预测价值

Predictive value of early viscoelastic coagulation function for coagulation dysfunction in heat stroke patients

目的构建基于早期黏弹性凝血功能的预测模型,并分析该预测模型预测热射病患者凝血功能障碍发生的预测价值。方法纳入2017年6月—2020年10月救治的100例热射病患者为研究对象,入院时收集所有患者早期黏弹性凝血功能指标,记录凝血功能障碍发生情况。采用多因素logistic回归方程分析早期黏弹性凝血功能指标与热射病患者凝血功能障碍发生的相关性,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)评估预测模型预测热射病患者凝血功能障碍发生的效能。结果100例热射病患者中有33例发生凝血功能障碍。发生组患者C反应蛋白(C-reactive protein,CRP)、凝血酶原时间(prothrombin time,PT)、血小板计数、凝血率(clotrate,CR)、血小板功能(platelet factor,PF)高于未发生组,活化凝血时间(activated clotting time,ACT)、纤维蛋白原(Fibrinogen,FI)低于未发生组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示:CRP升高(OR=1.616)、CR升高(OR=1.240)、PF升高(OR=2.132)是热射病患者凝血功能障碍发生的危险因素(P<0.05),ACT升高(OR=0.885)是热射病患者凝血功能障碍发生的保护因素(P<0.05)。ROC曲线分析结果显示:联合CRP、ACT、CR、PF建立的预测模型预测热射病患者凝血功能障碍发生的AUC为0.929,灵敏度为83.41%,特异度为79.22%。结论早期ACT、CR、PF高水平状态是热射病患者凝血功能障碍发生的影响因素,早期黏弹性凝血功能检测指标可用于热射病患者凝血功能障碍的早期预测。

Objective To construct a prediction model based on early viscoelastic coagulation function and analyze its predictive value for coagulation dysfunction in heat stroke patients.Methods A total of 100 heat stroke patients treated from June 2017 to October 2020 were included in this study.Early viscoelastic coagulation function indicators were collected upon admission,and the occurrence of coagulation dysfunction was recorded.Multivariate logistic regression analysis was used to analyze the correlation between early viscoelastic coagulation function indicators and the occurrence of coagulation dysfunction.Receiver operating characteristic curves(ROC)were drawn to evaluate the efficacy of the prediction model in predicting the occurrence of coagulation dysfunction in heat stroke patients.Results Among the 100 heat stroke patients,33 patients had occurrence of coagulation dysfunction.The patients with coagulation dysfunction had higher levels of C-reactive protein(CRP),prothrombin time(PT),platelet count,clot rate(CR),and platelet factor(PF),as well as lower levels of activated clotting time(ACT)and fibrinogen(FI),compared to the patients without coagulation dysfunction(all indicators,P<0.05).Multivariate logistic regression analysis showed that elevated CRP(OR=1.616),CR(OR=1.240),and PF(OR=2.132)were risk factors for coagulation dysfunction in heat stroke patients(P<0.05),while elevated ACT(OR=0.885)was a protective factor(P<0.05).ROC curve analysis showed that the AUC of the prediction model established with CRP,ACT,CR,and PF was 0.929 for predicting coagulation dysfunction in heat stroke patients,with a sensitivity of 83.41%and a specificity of 79.22%.Conclusions Elevated levels of ACT,CR,and PF at early stages were influencing factors for the occurrence of coagulation dysfunction in heat stroke patients.Early viscoelastic coagulation function indicators could be used for early prediction of coagulation dysfunction in heat stroke patients.