脓毒症性凝血病修正评分系统的临床价值分析

Clinical value analysis of sepsis⁃induced coagulopathy modified scoring system

目的探讨脓毒症性凝血病(SIC)修正评分系统的临床意义。方法回顾性分析第九〇八医院重症医学科自2018年5月至2021年4月期间收治的脓毒症患者,根据SIC修正评分分为普通脓毒症组(n=222)和脓毒症性凝血病组(n=120),比较两组患者入科2 h内的急性生理与慢性健康(APACHEⅡ)评分、血常规、肝肾功能、乳酸水平和凝血功能试验指标;采用受试者工作特征曲线(ROC)分析SIC修正评分系统对弥散性血管内凝血(DIC)和患者预后的判断价值;并与国际血栓与止血学会(ISTH)SIC评分系统进行比较。结果与普通脓毒症组的APACHEⅡ评分[(21.76±6.84)分]和重症监护病房(ICU)病死率(20.3%)比较,脓毒症性凝血病组患者的APACHEⅡ评分[(26.07±6.56)分]和ICU病死率(48.3%)显著升高(P<0.05)。与普通脓毒症组比较,脓毒症性凝血病患者的APTT及TT延长,纤维蛋白原及抗凝血酶水平下降,FDP和D⁃二聚体水平显著升高(P<0.05);血栓弹力图(TEG)的R及K值显著延长,Angle显著缩小,MA值显著增加(P<0.05);血浆TM、TAT及t⁃PAIC水平均显著升高(P<0.05)。ROC分析显示ISTH⁃SIC评分预测DIC发生的曲线下面积为0.91,ISTH⁃SIC评分界值为4分时,其敏感度和特异度分别为1.00和0.63。SIC修正评分系统预测DIC发生的曲线下面积为0.94,取修正SIC评分界值为4分时,其敏感度和特异度分别为1.00和0.73。SIC修正评分系统预测DIC发生的AUC显著高于SIC评分,且差异具有统计学意义(P=0.013)。结论SIC修正评分系统可以提高识别SIC和预测DIC发生的特异度。

Objective To investigate the clinical significance of the modified scoring system for sepsis⁃induced coagulopathy(SIC).Methods A retrospective analysis was performed on patients with sepsis admitted to the Department of Critical Care Medicine of the 908 th Hospital of PLA Joint Logistic Support Force from May 2018 to April 2021.The patients were divided into two groups according to the modified SIC scoring system:sepsis group(n=222)and SIC group(n=120).The APACHEⅡscores,blood test results,liver and kidney function markers,lactate levels,and coagulation profile of patients within two hours of their admission to the intensive care unit(ICU)were compared between the two groups.The predictive and prognostic value of the modified SIC scoring system for disseminated intravascular coagulation(DIC)were compared with the International Society on Thrombosis and Haemostasis(ISTH)SIC scoring system by the receiver operating characteristic(ROC)curve analysis.Results The APACHEⅡscores in the sepsis⁃induced coagulopathy(SIC)group[(26.07±6.56)points]were significantly higher compared to the sepsis group[(21.76±6.84)points],as was the ICU mortality rate[48.3%versus 20.3%],with these differences being statistically significant(P<0.05).Patients with sepsis⁃induced coagulopathy(SIC)exhibited significantly prolonged activated partial thromboplastin time(APTT)and thrombin time(TT),reduced levels of fibrinogen and antithrombin,as well as significantly elevated levels of fibrin degradation products(FDP)and D⁃dimer,compared to the sepsis group(P<0.05).Additionally,thromboelastography(TEG)parameters such as the R and K values were significantly increased,the Angle was notably decreased,and the maximum amplitude(MA)value was significantly higher in the SIC group(P<0.05).Furthermore,plasma levels of thrombomodulin(TM),thrombin⁃antithrombin complex(TAT),and tissue plasminogen activator⁃inhibitor complex(t⁃PAIC)were all significantly elevated in the SIC group(P<0.05).ROC analysis showed that the area under the curve(AUC)of ISTH⁃SIC scores for DIC prediction was 0.91.At a SIC,score of 4 points,the sensitivity and specificity were 1.00 and 0.63,respectively.The AUC of the SIC modified scoring system for DIC prediction was 0.94.At a mSIC score of 4 points,the sensitivity and specificity were 1.00 and 0.73,respectively.The AUC of the modified SIC scoring system for DIC prediction was significantly higher than that of ISTH⁃SIC scoring system,and the difference was statistically significant(P=0.013).Conclusion The modified SIC scoring system enhances the specificity of diagnosing SIC and predicting the onset of DIC.